Limited value of routine followup CT scans in nonoperative management of blunt liver and splenic injuries.
The objective was to determine the utility of a second CT scan in nonoperative management of blunt liver and splenic trauma. The design was a retrospective review of consecutive cases over a 2-year period in two trauma centers. Subjects were 152 patients with blunt abdominal trauma and isolated injuries to liver and/or spleen. Thirty patients received immediate laparotomy, whereas 122 patients (80%) underwent CT scanning that showed splenic (n = 64), liver (n = 44), or combined (n = 14) injuries. Nonoperative management was undertaken in 99 of the 122 (81% of the patients who received CT scans; 65% of the overall series) and was ultimately successful in 94 (95%). Second CT scans were used in 26 patients (26%), one of whom received laparotomy for drainage of a bile leak and three for ongoing bleeding. None of the followup scans showed major progression of injury, and scan findings did not influence decisions for operation in any patients. Routine followup CT scanning is not a justifiable component of nonoperative management protocols for blunt liver and splenic injuries.
Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
A
A
Allins
T
T
Ho
T H
TH
Nguyen
M
M
Cohen
K
K
Waxman
J R
JR
Hiatt
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D017063:Outcome Assessment, Health Care; D010532:Peritoneal Diseases / Q000601:surgery; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000191:economics; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*