Routine follow-up imaging is unnecessary in the management of blunt hepatic injury

Jordy C. Cox, Timothy C. Fabian, George O. Maish, Tiffany K. Bee, F. Elizabeth Pritchard, Stephan E. Russ, Dara Grieger, Marie I. Winestone, Ben L. Zarzaur, Martin A. Croce, Gail T. Tominaga, J. H. Patton, Juan A. Asensio

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Nonoperative management of hemodynamically stable patients with blunt hepatic injuries has become the standard of care over the past decade. However, controversy regarding the role of in-hospital follow-up computed tomographic (CT) scans as a part of this non-operative management scheme is ongoing. Although many institutions, including our own, have advocated routine in-hospital follow-up scans, others have suggested a more selective policy. Over time, we have perceived a low yield from follow-up studies. The hypothesis for this study is that routine follow-up imaging of asymptomatic patients is unnecessary. Methods: All patients selected for nonoperative management of blunt hepatic injury were evaluated for utility of follow-up CT scans over a 4-year period. Results: There were 530 stable patients with hepatic injury on admission CT scans in which follow-up scans were obtained within a week of admission. All injuries were classified according to the revised American Association for the Surgery of Trauma Organ Injury Scale: 102 (19.2%) grade I, 181 (34.1%) grade II, 158 (29.8%) grade III, 74 (13.9%) grade IV, and 15 (2.8%) grade V. Follow-up scans showed that most injuries were either unchanged (51%) or unproved (34.7%). Only three patients underwent intervention based on their follow-up scans: two patients had arteriography (one with therapeutic embolization) and one had percutaneous drainage. Each of those patients had clinical signs or symptoms that were indicative of ongoing hepatic abnormality. Conclusion: These data demonstrate that, regardless of injury grade, routine in-hospital follow-up scans are not indicated as part of the nonoperative management of blunt liver injuries. Follow-up scans are indicated for patients who develop signs or symptoms suggestive of hepatic abnormality.

Original languageEnglish
Pages (from-to)1175-1180
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number5
DOIs
StatePublished - Nov 2005

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Nonpenetrating Wounds
Liver
Wounds and Injuries
Signs and Symptoms
Therapeutic Embolization
Standard of Care
Drainage
Angiography

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Routine follow-up imaging is unnecessary in the management of blunt hepatic injury. / Cox, Jordy C.; Fabian, Timothy C.; Maish, George O.; Bee, Tiffany K.; Pritchard, F. Elizabeth; Russ, Stephan E.; Grieger, Dara; Winestone, Marie I.; Zarzaur, Ben L.; Croce, Martin A.; Tominaga, Gail T.; Patton, J. H.; Asensio, Juan A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 5, 11.2005, p. 1175-1180.

Research output: Contribution to journalArticle

Cox, JC, Fabian, TC, Maish, GO, Bee, TK, Pritchard, FE, Russ, SE, Grieger, D, Winestone, MI, Zarzaur, BL, Croce, MA, Tominaga, GT, Patton, JH & Asensio, JA 2005, 'Routine follow-up imaging is unnecessary in the management of blunt hepatic injury', Journal of Trauma - Injury, Infection and Critical Care, vol. 59, no. 5, pp. 1175-1180. https://doi.org/10.1097/01.ta.0000189003.01375.71
Cox, Jordy C. ; Fabian, Timothy C. ; Maish, George O. ; Bee, Tiffany K. ; Pritchard, F. Elizabeth ; Russ, Stephan E. ; Grieger, Dara ; Winestone, Marie I. ; Zarzaur, Ben L. ; Croce, Martin A. ; Tominaga, Gail T. ; Patton, J. H. ; Asensio, Juan A. / Routine follow-up imaging is unnecessary in the management of blunt hepatic injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 5. pp. 1175-1180.
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abstract = "Background: Nonoperative management of hemodynamically stable patients with blunt hepatic injuries has become the standard of care over the past decade. However, controversy regarding the role of in-hospital follow-up computed tomographic (CT) scans as a part of this non-operative management scheme is ongoing. Although many institutions, including our own, have advocated routine in-hospital follow-up scans, others have suggested a more selective policy. Over time, we have perceived a low yield from follow-up studies. The hypothesis for this study is that routine follow-up imaging of asymptomatic patients is unnecessary. Methods: All patients selected for nonoperative management of blunt hepatic injury were evaluated for utility of follow-up CT scans over a 4-year period. Results: There were 530 stable patients with hepatic injury on admission CT scans in which follow-up scans were obtained within a week of admission. All injuries were classified according to the revised American Association for the Surgery of Trauma Organ Injury Scale: 102 (19.2{\%}) grade I, 181 (34.1{\%}) grade II, 158 (29.8{\%}) grade III, 74 (13.9{\%}) grade IV, and 15 (2.8{\%}) grade V. Follow-up scans showed that most injuries were either unchanged (51{\%}) or unproved (34.7{\%}). Only three patients underwent intervention based on their follow-up scans: two patients had arteriography (one with therapeutic embolization) and one had percutaneous drainage. Each of those patients had clinical signs or symptoms that were indicative of ongoing hepatic abnormality. Conclusion: These data demonstrate that, regardless of injury grade, routine in-hospital follow-up scans are not indicated as part of the nonoperative management of blunt liver injuries. Follow-up scans are indicated for patients who develop signs or symptoms suggestive of hepatic abnormality.",
author = "Cox, {Jordy C.} and Fabian, {Timothy C.} and Maish, {George O.} and Bee, {Tiffany K.} and Pritchard, {F. Elizabeth} and Russ, {Stephan E.} and Dara Grieger and Winestone, {Marie I.} and Zarzaur, {Ben L.} and Croce, {Martin A.} and Tominaga, {Gail T.} and Patton, {J. H.} and Asensio, {Juan A.}",
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T1 - Routine follow-up imaging is unnecessary in the management of blunt hepatic injury

AU - Cox, Jordy C.

AU - Fabian, Timothy C.

AU - Maish, George O.

AU - Bee, Tiffany K.

AU - Pritchard, F. Elizabeth

AU - Russ, Stephan E.

AU - Grieger, Dara

AU - Winestone, Marie I.

AU - Zarzaur, Ben L.

AU - Croce, Martin A.

AU - Tominaga, Gail T.

AU - Patton, J. H.

AU - Asensio, Juan A.

PY - 2005/11

Y1 - 2005/11

N2 - Background: Nonoperative management of hemodynamically stable patients with blunt hepatic injuries has become the standard of care over the past decade. However, controversy regarding the role of in-hospital follow-up computed tomographic (CT) scans as a part of this non-operative management scheme is ongoing. Although many institutions, including our own, have advocated routine in-hospital follow-up scans, others have suggested a more selective policy. Over time, we have perceived a low yield from follow-up studies. The hypothesis for this study is that routine follow-up imaging of asymptomatic patients is unnecessary. Methods: All patients selected for nonoperative management of blunt hepatic injury were evaluated for utility of follow-up CT scans over a 4-year period. Results: There were 530 stable patients with hepatic injury on admission CT scans in which follow-up scans were obtained within a week of admission. All injuries were classified according to the revised American Association for the Surgery of Trauma Organ Injury Scale: 102 (19.2%) grade I, 181 (34.1%) grade II, 158 (29.8%) grade III, 74 (13.9%) grade IV, and 15 (2.8%) grade V. Follow-up scans showed that most injuries were either unchanged (51%) or unproved (34.7%). Only three patients underwent intervention based on their follow-up scans: two patients had arteriography (one with therapeutic embolization) and one had percutaneous drainage. Each of those patients had clinical signs or symptoms that were indicative of ongoing hepatic abnormality. Conclusion: These data demonstrate that, regardless of injury grade, routine in-hospital follow-up scans are not indicated as part of the nonoperative management of blunt liver injuries. Follow-up scans are indicated for patients who develop signs or symptoms suggestive of hepatic abnormality.

AB - Background: Nonoperative management of hemodynamically stable patients with blunt hepatic injuries has become the standard of care over the past decade. However, controversy regarding the role of in-hospital follow-up computed tomographic (CT) scans as a part of this non-operative management scheme is ongoing. Although many institutions, including our own, have advocated routine in-hospital follow-up scans, others have suggested a more selective policy. Over time, we have perceived a low yield from follow-up studies. The hypothesis for this study is that routine follow-up imaging of asymptomatic patients is unnecessary. Methods: All patients selected for nonoperative management of blunt hepatic injury were evaluated for utility of follow-up CT scans over a 4-year period. Results: There were 530 stable patients with hepatic injury on admission CT scans in which follow-up scans were obtained within a week of admission. All injuries were classified according to the revised American Association for the Surgery of Trauma Organ Injury Scale: 102 (19.2%) grade I, 181 (34.1%) grade II, 158 (29.8%) grade III, 74 (13.9%) grade IV, and 15 (2.8%) grade V. Follow-up scans showed that most injuries were either unchanged (51%) or unproved (34.7%). Only three patients underwent intervention based on their follow-up scans: two patients had arteriography (one with therapeutic embolization) and one had percutaneous drainage. Each of those patients had clinical signs or symptoms that were indicative of ongoing hepatic abnormality. Conclusion: These data demonstrate that, regardless of injury grade, routine in-hospital follow-up scans are not indicated as part of the nonoperative management of blunt liver injuries. Follow-up scans are indicated for patients who develop signs or symptoms suggestive of hepatic abnormality.

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