The CT risk factors for the need of operative treatment in initially hemodynamically stable patients after blunt hepatic trauma.
BACKGROUND
Most hemodynamically stable blunt hepatic trauma (BHT) patients are treated nonoperatively with a reported successful rate exceeding 80%. It is current clinical consensus that hemodynamic stability is the only determinant for a patient to be managed nonoperatively. However, conversion to operative treatment was found in around 10% of these patients.


METHODS
There were 214 computed tomography (CT) scans of hemodynamically stable patients with main or sole BHT studied. CT findings including injury severity grading, contrast extravasation, the amount of hemoperitoneum, the degree of maceration, the depth of laceration, the size of hematoma, and the involvement of great vessels were analyzed to determine risk factors leading to the need of operative treatment.


RESULTS
Intraperitoneal contrast extravasation, hemoperitoneum in six compartments, maceration >2 segments, high Mirvis' CT grade as well as American Association for the Surgery of Trauma injury scale, laceration > or =6 cm in depth, and porta hepatis involvement occurred significantly more frequently (p < or = 0.001, respectively) in patients who needed operative treatment. Logistic regression analysis identified "intraperitoneal contrast extravasation" (RR = 12.5, 95% CI: 7.8-20.0; p < 0.001) and "hemoperitoneum in six compartments" (RR = 22, 95% CI: 9.7-49.4; p < 0.001) to independently contribute to the need of operative treatment.


CONCLUSIONS
Intraperitoneal contrast extravasation and hemoperitoneum in six compartments on CT scan both indicate massive or active hemorrhage and should be regarded as high risk for the need of operation in hemodynamically stable patients after BHT. Patients with low risk profile can be successfully treated with nonoperative modalities.
Fang
Jen-Feng
JF
Trauma, Emergency Surgery, and Critical Care Center, Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan. jimfang@adm.cgmh.org.tw
Wong
Yon-Cheong
YC
Lin
Being-Chuan
BC
Hsu
Yu-Pao
YP
Chen
Miin-Fu
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000401:mortality; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy