Repeat Imaging in Blunt Hepatic Injuries Can Wait for Clinical Change

Fletcher, Kelsey L.; Perea, Lindsey L; Morgan, Madison; Otaibi, Banan W.; Hazelton, Joshua P.

doi:10.1016/j.jss.2021.06.049

Cited by 5 publications

(11 citation statements)

References 12 publications

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Section: Discussionmentioning

confidence: 99%

“…With this limitation in mind, we defined the CC group as imaging performed due to patient symptoms, vital sign changes, or laboratory abnormalities, and the NCC group as imaging performed on a routine basis including that which followed an institutional protocol or recommendation. 17 Patients who underwent repeat imaging included those who underwent initial operative (damage control laparotomy, laparotomy for concomitant injuries, splenectomy, splenorrhaphy, etc. ), interventional radiologic (embolization, etc.…”

Section: Discussionmentioning

confidence: 99%

“…The methodology is previously described in the author’s prior published work, with modifications for the current study elaborated below. 17…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…12 Several studies have shown association between clinical changes and the presence of delayed complications, thus recommending reliance on clinical factors to prompt repeat imaging. 2,17,18 However, the potential life-threatening nature of delayed complications, particularly PSA and subsequent rupture, has led to continued recommendations for routine follow-up CT regardless of injury grade. 1,3,11,15,16 The aim of this study was to examine the rate of organspecific delayed complications and subsequent interventions in adult trauma patients with blunt splenic injury; specifically, those patients who undergo repeat imaging during their index hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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

Perea

Fletcher

Morgan

et al. 2022

Trauma

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Background There are no definitive recommendations guiding repeat imaging, or its timing, in patients with blunt splenic injury managed non-operatively. This study examines delayed complications and interventions in patients with blunt splenic injuries who undergo repeat imaging. Imaging was prompted either by a clinical change (CC) or non-clinical change (NCC) including institutional recommendations and individual physician practice patterns. Methods A 3-year, retrospective, dual-institution study was conducted of adult patients with blunt splenic injuries. Patients who underwent repeat imaging were grouped based on the reason for scan: CC or NCC. The incidence of delayed complications and interventions was examined. Results Of 235 patients, 105 (45%) underwent repeat imaging [CC n = 67 (64%), NCC n = 38 (36%)]. Median time to repeat imaging was shorter in the NCC group [CC = 96 (IQR 48–192) hours, NCC = 48 (IQR 36–68) hours, p = .0005]. Delayed complications were found in 28 (42%) CC patients versus 18 (47%) NCC patients ( p = .683). Interventions for complications were performed in 6 (21%) CC versus 10 (56%) NCC ( p = .027). Discussion Nearly half of patients reimaged because of NCC were found to have complications, with more than half undergoing intervention. Complications were identified and treated earlier in the NCC group than the CC group. This suggests patients with blunt splenic injuries should undergo routine repeat imaging to allow for prompt identification and treatment of delayed complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The methodology is previously described in the author’s prior published work, with modifications for the current study elaborated below. 17…”

Section: Methodsmentioning

confidence: 99%