The role of computed tomographic scan in ongoing triage of operative hepatic trauma: A Western Trauma Association multicenter retrospective study

The Journal of Trauma and Acute Care Surgery
Matthew E KutcherJason L Sperry

Abstract

A subset of patients explored for abdominal injury have persistent hepatic bleeding on postoperative computed tomography (CT) and/or angiography, either not identified or not manageable at initial laparotomy. To identify patients at risk for ongoing hemorrhage and guide triage to angiography, we investigated the relationship of early postoperative CT scan with outcomes in operative hepatic trauma. This is a retrospective review of 528 patients with hepatic injury taken to laparotomy without imaging within 6 hours of arrival to six trauma centers from 2007 to 2013, coordinated through the Western Trauma Association multicenter trials group. A total of 528 patients were identified, with a mean age of 31 years, 82% male, and 37% blunt injury; mean (SD) Injury Severity Score (ISS) was 27 (16) and base deficit was -9 (6); in-hospital mortality was 26%. Seventy-three patients died during initial exploration. Of 455 early survivors, 123 (27%) had a postoperative contrast CT scan within 24 hours of laparotomy. CT patients had more common blunt injury, higher ISS, and lower base deficit than those who did not undergo CT. CT identified hepatic contrast extravasation or pseudoaneurysm in 10 patients (8%). Hepatic bleeding on CT was 83% se...Continue Reading

References

Jun 5, 2002·The Journal of Trauma·Jon W JohnsonC William Schwab
Dec 17, 2003·The Journal of Trauma·Alicia M MohrDavid H Livingston
Apr 26, 2005·Journal of the American College of Surgeons·J David Richardson
Dec 31, 2005·The Journal of Trauma·Jordy C CoxMartin A Croce
Oct 13, 2009·The Journal of Trauma·Timothy S MisselbeckMichael M Badellino

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Citations

Dec 17, 2015·The Journal of Trauma and Acute Care Surgery·Christopher S GreenSharon W Kwan
Mar 12, 2020·Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes·Saira HamidSadia Raheez Qamar
Sep 21, 2017·The Journal of Trauma and Acute Care Surgery·April E MendozaMargaret M Knudson
Jul 10, 2019·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Lauren F AlexanderPeter A Harri
Jan 25, 2020·The Journal of Trauma and Acute Care Surgery·Kazuhide MatsushimaDemetrios Demetriades
Dec 22, 2020·The American Surgeon·Ali Cadili, Jonathan Gates
Feb 2, 2021·Trauma Surgery & Acute Care Open·Melike Harfouche, David V Feliciano

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