Routine follow-up imaging is unnecessary in the management of blunt hepatic injury.
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 nonoperative 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 improved (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.


CONCLUSIONS
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.
Cox
Jordy C
JC
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Fabian
Timothy C
TC
Maish
George O
GO
Bee
Tiffany K
TK
Pritchard
F Elizabeth
FE
Russ
Stephan E
SE
Grieger
Dara
D
Winestone
Marie I
MI
Zarzaur
Ben L
BL
Croce
Martin A
MA
D003266:Continuity of Patient Care; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008107:Liver Diseases / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*