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 language | English |
|---|---|
| Pages (from-to) | 1175-1180 |
| Number of pages | 6 |
| Journal | Journal of Trauma - Injury, Infection and Critical Care |
| Volume | 59 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2005 |
Fingerprint
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 journal › Article
}
TY - JOUR
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.
UR - http://www.scopus.com/inward/record.url?scp=30344454404&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=30344454404&partnerID=8YFLogxK
U2 - 10.1097/01.ta.0000189003.01375.71
DO - 10.1097/01.ta.0000189003.01375.71
M3 - Article
C2 - 16385297
AN - SCOPUS:30344454404
VL - 59
SP - 1175
EP - 1180
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 5
ER -