Management of blunt hepatic and splenic trauma in Austria: a national questionnaire study

Abstract

Background: Treatment of hepatic and splenic injuries has significantly evolved over the past 30 years: Non-operative management (NOM) has increasingly become standard of care for the majority of patients in specialised centres. However, patient selection and details of practical management such as time to reinitiating oral intake, duration of restricted activity, or necessity of repeated imaging are still a matter of debate. This national multicentre questionnaire study aims to give a cross-sectional overview of current management of blunt liver and splenic trauma in Austrian hospitals. Methods: The survey was addressed to all Austrian surgical departments and trauma units. After three months, responses were electronically and anonymously recorded, data were analysed using descriptive statistics. Data collection involved electronic-based questionnaires comprising questions on centre structure, selection criteria for NOM and practical aspects of consecutive treatment. Results: In total, a 60% response rate could be achieved, and 24% of all contacted centres filled out the full questionnaire completely. A widespread shift to NOM within recent years could be observed. More than 70% of injuries were treated conservatively. Forty percent of hospitals currently follow a clinical algorithm. Further details about specific questionnaire results are presented, revealing diverse approaches in a number of treatment aspects. Conclusion: Non-operative management is the standard of care for blunt hepatic and splenic injuries in Austria. In many clinically relevant questions there is still a lack of consensus. Based on this experience, national standard protocols may be generated for systematisation of care in blunt liver and spleen trauma.