title: Nonoperative management of blunt hepatic trauma: A systematic review.
abstract: BACKGROUND
  Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma.
  
  
  METHODS
  Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials.
  
  
  RESULTS
  We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p < 0.05), fluid resuscitation (p = 0.02), blood transfusion (p = 0.003), peritoneal signs (p < 0.0001), Injury Severity Score (ISS) (p = 0.03), and associated intra-abdominal injuries (p < 0.01).
  
  
  CONCLUSIONS
  There is evidence that patients presenting with clinical signs of shock, a high ISS, associated intra-abdominal injuries, and peritoneal signs are at an increased risk of failure of NOM for the treatment of blunt hepatic injuries.
  
  
  METHODS
  Systematic review, level III.
authors.affiliation: From the Department of Orthopaedic and Trauma Surgery (C.K.B., M.H., L.P.M.), University Hospital of Cologne, Cologne; and Department of Trauma, Hand and Reconstructive Surgery (S.R., M.F., P.L.), University of Giessen and Marburg, Marburg, Germany.
authors.forename: Christoph Kolja
authors.initials: CK
authors.lastname: Boese
authors.forename: Michael
authors.initials: M
authors.lastname: Hackl
authors.forename: Lars Peter
authors.initials: LP
authors.lastname: Müller
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Michael
authors.initials: M
authors.lastname: Frink
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
mesh_terms: D006801:Humans; D008099:Liver / Q000293:injuries*; D011379:Prognosis; D012307:Risk Factors; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000628:therapy*