Safety of Early Mobilization of Patients With Blunt Solid Organ Injuries

London, Jason A.; Parry, Lisa; Galante, Joseph M.; Battistella, Felix D.

doi:10.1001/archsurg.143.10.972

Cited by 63 publications

(46 citation statements)

References 32 publications

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“…London et al 17. retrospectively reviewed time to mobility in patients with various solid organ injuries and reported that early mobilization did not correlate with a higher rate of NOM failure.…”

Section: Discussionmentioning

confidence: 99%

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

Uchida

Mizobata

Hagawa

et al. 2018

Acute Medicine & Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Uchida

Mizobata

Hagawa

et al. 2018

Acute Medicine & Surgery

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“…Liver injuries, in line with other solid organ injuries managed non-operatively, have traditionally included a prolonged period of bed rest. The evidence for this is absent, and in a large study, London et al reported the day of bed rest on which failure of SNOM occurred in renal, hepatic and splenic blunt trauma [111]. Although the numbers of SNOM failures were small, there was no relationship to duration of bed rest.…”

Section: Ongoing Monitoring Of the Non-operatively Managed Patientmentioning

confidence: 99%

Non-Operative Management of Liver Trauma

Swift

Garner

2012

J R Army Med Corps

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The liver is one of the commonest intra-abdominal organs injured worldwide in blunt and penetrating trauma and its management has evolved significantly in the last 30 years. Mandatory laparotomy has been replaced by an acceptance that for most blunt hepatic trauma, a selective non-operative approach is safe and effective with a failure rate ie the need to proceed to delayed laparotomy of approximately 10%. There is a markedly lower rate of complications in those that are managed non-operatively. Adjuncts to this conservative regimen such as angioembolisation and delayed laparoscopy to treat biliary peritonitis increase the chances of avoiding laparotomy. This belief in non-operative management has also been transferred to some degree to penetrating liver trauma, where there is a gradual accumulation of evidence to support this non-operative approach in a carefully selected group of patients. This article examines the evidence supporting the selective non-operative management of both blunt and penetrating liver trauma and describes the outcomes and complications.

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“…In fact, the only study to specifically evaluate the association of bedrest with NOM failure in adults found no correlation [19]. All three St Peter et al studies as well as the two Arkansas studies and a smaller study done in Seattle showed safety for an abbreviated period of bedrest in more than 600 unique patients with good follow-up [ sooner in renal injury) for all patients with stable hemoglobin.…”

Section: Abbreviated Bedrestmentioning

confidence: 99%