title: Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database.
abstract: BACKGROUND
  Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries.
  
  
  METHODS
  A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined.
  
  
  RESULTS
  Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group.
  
  
  CONCLUSIONS
  The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients with blunt hepatic injury.
authors.affiliation: General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel. Electronic address: foratola@gmail.com.
authors.forename: Forat
authors.initials: F
authors.lastname: Swaid
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
authors.affiliation: Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alfici
authors.affiliation: General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Matter
authors.affiliation: Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Olsha
authors.affiliation: Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Ashkenazi
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Givon
authors.affiliation: Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Kessel
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology
keywords: Blunt liver injury; Blunt spleen injury; Hollow viscus injury; Non-operative management