title: Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury.
abstract: BACKGROUND
  Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan.
  
  
  METHODS
  From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success.
  
  
  RESULTS
  A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma.
  
  
  CONCLUSIONS
  Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.
authors.affiliation: School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Yi-Chieh
authors.initials: YC
authors.lastname: Huang
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Yung-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Lu
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013161:Splenic Rupture / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D055815:Young Adult