7 - A Nationwide Australian Cross-Sectional Study Assessing Current Practices of Infection Prevention After Splenic Artery Embolization Following Trauma.

Management of patients after trauma splenic injury and Splenic Artery Embolization (SAE) varies widely {1}. This study aimed to assess current practice across Australia with a focus on post-SAE immune function testing, aiming to provide evidence for consensus recommendations in the future.

Materials and Methods:

Approval was obtained from our IRB. A 29-question survey was sent via the Australian and New Zealand Trauma Registry {2} to all 28 trauma hospitals that contribute to the registry. Questions were asked based on data from the 2022 calendar year. All surveys were included even if data points were missing. Pediatric sites were included.

Responses were received from 12 hospitals (43%) including 6 of 8 regions (75%). This included 7 sites (58%) registered as quaternary trauma centres. Of the responding hospitals, 10 (83%) offer SAE via a 24-hour 7-day rostered service.

Results:

Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 SAE per hospital (range 0-65). SAE constituted 31% of all splenic management, with conservative in 65%, and splenectomy in 4%. 8 sites (67%) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67%), which included 80% of adult hospitals. Distal SAE was the predominant treatment type (70%). Patients were routinely admitted for median 4 days after SAE (range 2-5).

Routine inpatient antibiotics were administered to SAE patients at 2 sites (17%) while only 1 site (8%) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36%), and 3 sites (25%) recommend vaccinations in the future.

11 sites (92%) follow-up patients in an outpatient clinic, varying between trauma, general surgery, infectious disease, and interventional radiology. Written information on SAE was given to patients at 9 hospitals (75%) while splenic function testing was performed at 5 sites (42%) consisting of Red Cell Morphology (20%) and Howell-Jolly Bodies (80%). 11 sites (92%) would change clinical practice in the future if evidence on splenic immune function would evolve.

Conclusion:

Most sites across Australia had systems for offering SAE after high-grade injury, with a high nationwide splenic salvage rate of 96%. The use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice represented in this study.