Sanford Research Team Publishes Study on Traumatic Spleen Injuries

by Ariana Mount 

The idea for Dr. Michael Burt’s latest research came to him the way many good ideas are born -- from a mistake.

The general surgery resident at the University of South Dakota Sanford School of Medicine was doing mock oral boards tests with his fellow residents when he was asked a question about splenic injuries. “My decisions were not entirely correct,” he recalled. 

After that, his professor of surgery, John A. Weigelt, MD, told him to look deeper into splenic injury standard of care.

“The more I started looking into it, the more I started to see the data is conflicted on indications for splenic artery embolization which requires specialized interventional radiology (IR) capabilities,” said Burt. “I plan on practicing general surgery in a rural community that more than likely will not have IR available, so I decided to look into what resources patients with blunt splenic injury actually required after they were transferred to our tertiary center.” 

Burt decided to dive into the research, to challenge the common standard of care that transfers patients with splenic injuries in rural hospitals to Level I or II Trauma Centers. Weigelt helped Burt as the principal investigator on the study, along with Professor Gary Timmerman, MD, Jenny Guido, MD, and medical student Christian Tobin. The team retrospectively studied data from 134 patients who had traumatic spleen accidents from 2011-2021 and were transferred to the Sanford Health Medical Centers in Fargo, North Dakota (Level I Trauma Center), Bismarck, North Dakota (Level II Trauma Center) and Sioux Falls, South Dakota (Level II Trauma Center) from small rural hospitals in the Dakotas. 

Burt and his Sanford Research team studied the patient data to determine, based on what the patients had done at the Sanford trauma hospitals, if that care could’ve been done by a general surgeon at the smaller town’s rural hospital. The results of the study showed 84% of these patients were treated successfully without splenic artery embolization, 57% of the patients required no blood product transfusion and 84% required less than three units of blood products, which is readily available at most rural hospitals. 

“The data demonstrated that, in the absence of other injuries necessitating transfer to a tertiary trauma center, the majority of patients with blunt splenic injury can reasonably be managed by a general surgeon at a rural hospital,” said Burt.

Burt explained if a rural hospital does not have a general surgeon on site, that patient would still need to be transferred to a hospital with a surgeon in case the patient required a splenectomy.

This idea of splenic injury standard of care isn’t new, however. Timmerman says this is how he practiced nearly 40 years ago as a rural general surgeon in Watertown, South Dakota. He says Burt’s findings that resurface and support this standard of care are beneficial to rural general surgeons and their patients.

“What it does, in my opinion, is it validates the general surgeon in those smaller communities,” said Timmerman. “And then [the patient] stays home, their family members are there, they don't have to travel one to two hours to see their family member. They don't have to get hotels because they are typically in Sioux Falls for two to three days.”

Burt and his research team presented the findings at the Northern Plains Rural Surgical Society in January of 2022, and the study was published in The American Surgeon in July. He hopes to one day investigate splenic injury patient data in other rural states, like Montana, Wyoming and Idaho to expand his research. 

After finishing residency in 2024, Burt plans to practice general surgery in a rural hospital himself.