LAUSR

BACKGROUND Leaving an injured solid organ in situ allows preservation of structure function but invites complications from the damaged parenchyma, including pseudoaneurysms (PSAs). Empiric PSA screening after solid organ injury is not yet established, particularly following penetrating trauma. Study objective was definition of delayed CT Angiography (dCTA) yield in triggering intervention for PSA after penetrating solid organ injury. METHODS Penetrating trauma patients at our ACS-verified Level 1 center with AAST grade ≥3 abdominal solid organ injury (liver, spleen, kidney) were retrospectively screened (01/2017-10/2021). Exclusions were age <18y, transfers, death <48h, and nephrectomy/splenectomy <4h. Primary outcome was intervention triggered by dCTA. Statistical testing with ANOVA/Chi squared compared outcomes between Screened vs. Unscreened patients. RESULTS 136 penetrating trauma patients met study criteria: 57 patients (42%) Screened for PSA with dCTA and 79 (58%) Unscreened. Liver injuries were most common (n=41, 64% vs. n=55, 66%), followed by kidney (n=21, 33% vs. 23, 27%), and spleen (n=2, 3% vs. 6, 7%) (p-0.48). Median AAST grade of solid organ injury was 3 [3-4] across groups (p=0.75). dCTA diagnosed 10 PSAs (18%) at a median of hospital day 5 [3-9]. Among Screened patients, dCTA triggered intervention in 17% of liver, 29% of kidney, and 0% of spleen-injured patients, for an overall yield of 23%. CONCLUSIONS Half of eligible penetrating high grade solid organ injuries were screened for PSA with dCTA. Delayed CTA identified a significant number of PSAs and triggered intervention in 23% of screened patients. dCTA did not diagnose any PSAs after splenic injury, although sample size hinders interpretation. To avoid missing PSAs and incurring their risk of rupture, universal screening of high grade penetrating solid organ injuries may be prudent.