Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy

Hsieh, Ting-Min; Tsai, Tsung Cheng; Liang, Jia; Lin, Chia‐Yu

doi:10.1186/1749-7922-9-51

Cited by 36 publications

(34 citation statements)

References 33 publications

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“…16 Study from Hsieh et al, Carillo et al, suggested that increasing need of blood transfusion was also a sign to manage the patient operatively. 2,18 It is in accordance with our study that blood transfusion is also a predictor failure in managing blunt liver trauma conservatively.…”

Section: Discussionsupporting

confidence: 77%

“…The advantages of NOM include lower hospital cost, earlier discharge, avoiding unnecessary laparotomy, fewer abdominal complication and reduced number of blood transfusion. 1,14,17 Most prior studies concluded that the main reason for the failure of NOM is the hemodynamic instability, whereas this observation was contradicted by Mitsusada et al 18,19 Various predictors of NOM failure have been documented in the literatures. [20][21][22][23][24][25][26][27][28][29] Literature review of Bhangu et al, reported AAST grades 4-5, the presence of moderate or large hemoperitoneum, increasing ISS and increasing age were significantly associated with increased risk factor of NOM failure in blunt liver injuries.…”

Section: Discussionmentioning

confidence: 77%

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Predictors of failure in non-operative management of blunt liver trauma

Winata¹,

Rudiman²

2017

Int Surg J

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Background: Liver is the most injured organ in abdominal trauma. Nonoperative treatment (NOM) is increasingly being adopted as the initial management strategy. The aim of this study was to evaluate the results of operative and conservative management of patients with blunt liver injury treated in a single institution.Methods: A retrospective study, analyzing patients admitted from 2011-2015 with the diagnosis of liver trauma, was performed. The patients were classified according to the intention to treatment: Group I, NOM; Group II, operative management and Group III, fail in NOM management. We analyzed demographic data, injury classification, associated injuries, transfusions, shock, liver function test, lactate level, and mortality rates.Results: Over the five years period, 68 patients were recorded, 45 were successful (S-NOM) and 18 were failed (F-NOM). No differences in age, sex or initial hemodynamics were found between S-NOM and F-NOM. The F-NOM patients were more seriously injured, more acidotic, required transfusion, had more fluid collection at FAST, had worse transaminase level and higher mortality rate. Grade of liver injuries was the independent risk factor of failure in nonoperating management of blunt liver trauma with the cut-off point is 3.66.Conclusions: Non-operative management of blunt liver injuries is successful in some cases. Patients with more severe injury tend to have an operation. High-grade blunt liver injuries always present with a worse condition and require an operation.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 77%

Predictors of failure in non-operative management of blunt liver trauma

Winata¹,

Rudiman²

2017

Int Surg J

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“…Boyuk et al (10) proposed that the failure rate is higher in patients who received more than 2 IU of RBC. Hsieh et al (17) reported that patients with a low hemoglobin level at admission and a high number of transfusion requirement in the intensive care unit were predictive for NOM failure.…”

Section: Discussionmentioning

confidence: 99%

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

et al. 2015

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“…Hence, the risk of failure with NOM is increased and

Extra vigilance is warranted during non-operative management of patients with trauma to both liver and spleen

extra vigilance is therefore warranted when choosing this form of therapy in the presence of injury to both organs [24]. In a retrospective protocol-driven study performed by Hsieh et al., a failure rate of 4.9% was described [25]. Other parameters that might be helpful in predicting the failure of NOM are lactate

lactate

levels on admission, necessity of transfusion, crystalloid resuscitation

crystalloid resuscitation

and drop-in haematocrit

haematocrit

levels during the first hour after admission [26].…”

Section: Success and Failure Of Non-operative Managementmentioning

confidence: 99%

Non-operative management of blunt hepatic and splenic injuries–practical aspects and value of radiological scoring systems

et al. 2018

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SummaryBackgroundNon-operative management (NOM) of blunt hepatic and splenic injuries has become popular in haemodynamically stable adult patients, despite uncertainty about efficacy, patient selection, and details of management. Up-to-date strategies and practical recommendations are presented.MethodsA selective literature search was conducted in PubMed and the Cochrane Library (1989–2016).ResultsNo randomized clinical trial was found. Non-randomized controlled trials and large retrospective and prospective series dominate. Few systematic reviews and meta-analyses are available. NOM of selected patients with blunt liver and spleen injuries is associated with low morbidity and mortality. Only data of limited evidence are available on intensity and duration of patient monitoring, repeat imaging, antithrombotic prophylaxis and return to normal activity. There is high-level evidence on early mobilisation and post-splenectomy vaccination.ConclusionNOM of blunt liver or spleen injuries is a worldwide trend, but the literature does not provide high-grade evidence for this strategy.

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Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy

Cited by 36 publications

References 33 publications

Predictors of failure in non-operative management of blunt liver trauma

Predictors of failure in non-operative management of blunt liver trauma

Independent Risk Factors for Failure of Nonoperative Management in Patients with Splenic Injury

Non-operative management of blunt hepatic and splenic injuries–practical aspects and value of radiological scoring systems

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