Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review

Boukar, Khadidja Malloum; Moore, Lynne; Tardif, Pier‐Alexandre; Soltana, Kahina; Yanchar, Natalie; Kortbeek, John B.; Champion, Howard R.; Clément, Julien

doi:10.1007/s00068-020-01584-x

Cited by 9 publications

(6 citation statements)

References 53 publications

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“…Multiple studies have shown that routine repeat CT imaging without clinical indication is not indicated in patients with hepatic injury 16,28,29 . Contrast CT imaging to screen for pseudoaneurysms following a high-grade solid organ injury has been slightly more controversial.…”

Section: Algorithmmentioning

confidence: 99%

“…Multiple studies have shown that routine repeat CT imaging without clinical indication is not indicated in patients with hepatic injury. 16,28,29 Contrast CT imaging to screen for pseudoaneurysms following a high-grade solid organ injury has been slightly more controversial. Hepatic artery pseudoaneurysm is a rare complication after hepatic trauma; however, risk of rupture and life-threatening hemorrhage has prompted many to advocate for routine follow-up screening with contrast CT. 30 Despite the associated high morbidity, there has not been routine adoption of a screening protocol to evaluate for delayed pseudoaneurysm diagnosis.…”

Section: Follow-up Ct Scanmentioning

confidence: 99%

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Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm

Keric,

Shatz,

Schellenberg

et al. 2023

J Trauma Acute Care Surg

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Section: Algorithmmentioning

confidence: 99%

Section: Follow-up Ct Scanmentioning

confidence: 99%

Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm

Keric,

Shatz,

Schellenberg

et al. 2023

J Trauma Acute Care Surg

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“…However, damage control laparotomy should be performed if the patient condition requires. Peritonitis caused by bleeding due to minor visceral damage such as liver and spleen damage in grade three or less organ damage, conservative treatment can be performed to avoid the second hit caused by surgery[ 14 , 15 ]. Peritonitis caused by extra-abdominal injuries, including pelvic fracture, pelvic hematoma, retroperitoneum hematoma, frequent reassessment and repeated image studies should be performed[ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Conservative management of multi-trauma induced peritonitis: Experience, outcomes, and indications

Chen,

Zhu,

Liu

et al. 2023

World J Clin Cases

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Insulin, a small protein with 51 amino acids synthesized by pancreatic β-cells, is crucial to sustain glucose homeostasis at biochemical and molecular levels. Numerous metabolic dysfunctions are related to insulin-mediated altered glucose homeostasis. One of the significant pathophysiological conditions linked to the insulin associated disorder is diabetes mellitus (DM) (type 1, type 2, and gestational). Insulin resistance (IR) is one of the major underlying causes of metabolic disorders despite its association with several physiological conditions. Metabolic syndrome (MS) is another pathophysiological condition that is associated with IR, hypertension, and obesity. Further, several other pathophysiological disorders/diseases are associated with the insulin malfunctioning, which include polycystic ovary syndrome, neuronal disorders, and cancer. Insulinomas are an uncommon type of pancreatic β-cell-derived neuroendocrine tumor that makes up 2% of all pancreatic neoplasms. Literature revealed that different biochemical events, molecular signaling pathways, microRNAs, and microbiota act as connecting links between insulin disorder and associated pathophysiology such as DM, insuloma, neurological disorder, MS, and cancer. In this review, we focus on the insulin-related disorders and the underlying mechanisms associated with the pathophysiology.

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“…Shapiro et al, in particular, reported that follow-up CT scans underestimated injury, possibly related to a progression of bleeding and delaying the timing of the operation. Boukar et al [ 107 ] reported evidence suggesting that routine CT follow-up of spleen injuries does not provide significant changes in clinical management. In their systematic review, seven studies reported whether a repeat CT scan during follow-up was routine (74%) or prompted by clinical indication (26%).…”

Section: Methodsmentioning

confidence: 99%

“…In aggregated data, a recent review stated that routine repeat CT without clinical indication was not helpful in blunt splenic injury managed non-operatively. However, the included studies showed imprecise effect estimates, and some were of low methodological quality [ 107 ]. A similar conclusion has been put forward by a single center using the US as a first-line follow-up, stating that clinical findings should indicate the need for radiological follow-up with CT as the preferred imaging modality [ 68 ].…”

Section: Methodsmentioning

confidence: 99%

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

et al. 2022

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Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

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Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review

Cited by 9 publications

References 53 publications

Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm

Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm

Conservative management of multi-trauma induced peritonitis: Experience, outcomes, and indications

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

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