The role of splenic angio-embolisation as an adjunct to non-operative management of blunt splenic injuries: a systematic review and meta-analysis.

Background: Non-operative management (NOM) of haemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional Splenic Angio-Embolisation (SAE) in patients with AAST grade IV and V BSI, but the role of SAE in grade III injuries is unclear and controversial. The aim of this systematic review is to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI. Methods: A systematic literature search (MEDLINE, EMBASE, CINAHL) was performed to identify original studies that compared outcomes in adult BSI patients treated with SAE or NOM alone. Primary outcome was failure of NOM. Secondary outcomes included morbidity, mortality, hospital length of stay, and transfusion requirements. Bayesian meta-analyses were used to calculate an absolute (Risk Difference, RD) and relative (Risk Ratio, RR) measure of treatment effect for each outcome. Results: Twenty-three studies (6684 patients) were included. For Grades I-V combined, there was no difference in NOM failure rate (SAE 8.6% versus NOM 7.7%; RR 1.09 [0.80 to 1.51]; P=0.28), mortality (SAE 4.8% versus NOM 5.8%; RR 0.82 [0.45 - 1.31]; P=0.81), hospital length of stay (11.3 versus 9.5 days; P=0.06), or blood transfusion requirements (1.8 versus 1.7 units; P=0.47), between patients treated with SAE and those treated with NOM alone. However, morbidity was significantly higher in patients treated with SAE (SAE 38.1% versus NOM 18.6%; RR 1.83 [1.20 - 2.66]; P

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