Study summary.

Background
The spleen is commonly injured in trauma and this may be managed with a conservative approach, embolisation or splenectomy. There is uncertainty how splenic embolisation fits into the treatment paradigm and the delivery of IR services remains variable.
Aims and objectives
The primary objectives are to determine if service design significantly affects splenic embolisation (SE) rates in AAST grade 2–5 acute traumatic splenic injuries (ATSI) across the Major Trauma Centres (MTCs) in England and to determine if variation in treatment affects SE outcomes in ATSI.
Methods
We will include 5 years of data from traumatic splenic injury patients in the MTCs from 01/01/2016 to 31/12/2020 available from the Trauma Audit and Research Network (TARN) database. Inclusion Criteria will be all patients with ATSI registered with TARN. Those without a CT available to grade radiologically will be excluded. Data available from the TARN database and then correlated with data that will be collected at each MTC, where detail as to the embolisation technique, specific injury pattern, imaging based follow up and patient survival will be available. A short service-based questionnaire will be sent to each centre to establish centre-specific details such as on call rota, IR response activation, reporting practices and capture data around routine decision-making at that site. Data will be collected on an anonymised (REDCap) database. This project will evaluate the impact of service design on embolisation rates and outcomes, as well as evaluating the impact of the variation upon treatment selection and outcomes. Logistic regression will be used to identify factors associated with treatment selection and mortality at 30 days.

背景：脾脏在创伤中常发生损伤，临床可采用保守治疗、栓塞术或脾切除术进行管理。目前对于脾栓塞术（splenic embolisation, SE）在创伤治疗范式中的定位尚不明确，且介入放射学（Interventional Radiology, IR）服务的实施模式仍存在较大差异。
研究目标与目的：本研究的主要目标为，明确英格兰境内各大创伤中心（Major Trauma Centres, MTCs）内，服务模式设计是否会对AAST（American Association for the Surgery of Trauma）分级2~5级的急性创伤性脾损伤（acute traumatic splenic injuries, ATSI）患者的脾栓塞术实施率产生显著影响；同时明确急性创伤性脾损伤患者的治疗差异是否会影响脾栓塞术的预后效果。
研究方法：本研究将纳入2016年1月1日至2020年12月31日期间，来自创伤审计与研究网络（Trauma Audit and Research Network, TARN）数据库的5年创伤性脾损伤患者数据，数据覆盖英格兰境内的各大创伤中心。纳入标准为所有在TARN登记的急性创伤性脾损伤患者，无可用影像学分级CT资料的患者将被排除。研究将首先从TARN数据库获取相关数据，随后将其与各创伤中心收集的补充数据进行关联分析，补充数据涵盖栓塞术操作细节、具体损伤分型、影像学随访情况以及患者生存结局。本研究将向各中心发放一份简短的服务相关调查问卷，以收集各中心的专属信息，包括值班排班表、介入放射学响应启动流程、报告规范，以及该中心日常诊疗决策相关的采集数据。所有数据将存储于匿名化的REDCap数据库中。本项目将评估服务模式设计对脾栓塞术实施率与预后效果的影响，同时分析治疗模式差异对治疗选择与预后结局的作用。研究将采用逻辑回归分析，以识别与治疗选择及30天死亡率相关的影响因素。