Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Abstract

AimBlunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow‐up imaging and appropriate observational admission.MethodsPatients with blunt splenic (S), liver (L), or kidney (K) injury treated with non‐operative management (NOM) in our institution were included and retrospectively reviewed.ResultsFrom January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic pseudoaneurysm on hospital day 6–7 and one patient with splenic delayed rupture on hospital day 7. The second follow‐up computed tomography scan carried out 1–2 days after admission did not show any significant findings that could help predict undesirable results of delayed events. The patients with delayed events had longer continuous abdominal pain than that of event‐free patients (P = 0.04).ConclusionsUndesirable delayed events were recognized on follow‐up computed tomography scans in 11.4% of NOM patients at hospital day 6–7 and tended to be associated with high‐grade splenic injuries and continuous symptoms. Repetitive screening of these patients 6–7 days after injury might be warranted because of the potential risk of delayed events.

Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: A multi-institutional observational study

“…This previous study suggested that follow-up enhanced CT performed approximately 1 week after injury may be useful to detect delayed SPA formation. Another retrospective observation study of adult patients with blunt injury to the torso visceral organs from Japan showed that the undesirable delayed events were recognized on follow-up CT scans in 11.4% of NOM patients at 6-7 days after hospitalization [21]. This previous study suggested that the second follow-up CT scan that was performed 1-2 days after admission did not help predict undesirable results of delayed events.…”

Routine repeat imaging of blunt splenic injuries identifies complications prior to clinical change

“…15,16 Other series advocate for using patient status in prompting repeat imaging, as all patients with reported delayed complications demonstrated a clinical change. 18,19 In fact, in a survey of members of the Eastern Association for the Surgery of Trauma (EAST), only 14.5% of respondents stated they would routinely obtain follow-up CT scans in all patients with blunt splenic injury. 12 Our data demonstrated delayed complications, including PSA, were found in 46 of 105 patients (43.8%) who underwent repeat imaging.…”

“…1,2,11,15,16 Given discordant recommendations, and lack of a standard practice, there continues to be variability in the utilization and timing of repeat imaging in adult patients with blunt splenic injury. 2,18,19 The current study aimed to compare repeat imaging based on the reason for scan (CC or NCC) in regard to delayed complications and interventions. Our data demonstrated that nearly half of patients with blunt splenic injuries reimaged based on NCC were found to have a delayed complication, with more than half of this group undergoing intervention.…”