• nonoperative management
• blunt splenic trauma
• Baltimore CT-grading

OBJECTIVE: to correlate in terms of sensitivity, specificity, positive/negative predictive values and diagnostic accuracy the Multi Detector Computed Tomography (MDCT) findings, ranked according to the Baltimore Grading System, with the management of blunt splenic injuries in multytrauma patients.

MATERIALS AND METHODS: thirty-six trauma patients (25 male, 11 female), mean age 40 years, were admitted to the Emergency Department in Pisa and underwent a contrast-enhanced MDCT (CEMDCT) with diagnosis of blunt splenic injury (study group). MDCT scans were obtained by using a 64 slices CT. MDCT results were collected retrospectively and then ranked according to the Baltimore Grading System criteria.

RESULTS: the MDCT findings were categorized as true positive, true negative, false positive or false negative to determine the sensitivity, specificity, positive and negative predictive value and accuracy of MDCT in suggesting the management of patients. The MDCT findings based on the Baltimore Grade had an overall sensitivity of 92.30%, specificity of 91.30%, positive predictive value of 85.71%, negative predictive value of 95.45% and diagnostic accuracy of 91.66%. Of all the hemodynamically stable patients at admission to the Emergency Radiology (thirty-three of thirty-six patients), thirty patients (91%) had a successful nonoperative management (NOM). Only in three patients (9%) NOM failed, leading to splenectomy, because of respectively post-embolization splenic abscess, post-embolization splenic rupture, and inability to catheterize the splenic artery.

CONCLUSION: the Baltimore Grading System of Blunt Splenic Injuries shows high sensitivity, specificity, negative predictive value and diagnostic accuracy in predicting the management of patients. In agreement with the literature data, our experience confirms that NOM of blunt splenic injuries is the standard of care in patients who are hemodynamically stable at admission to the Emergency Radiology.