Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial.
Martin A. Croce,Timothy C. Fabian,P G Menke,Lynda Waddle-Smith,Gayle Minard,Kenneth A. Kudsk,Joe H. Patton,Michael Schurr,F E Pritchard +8 more
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Evaluated the safety of nonoperative management of blunt hepatic trauma in hemodynamically stable patients regardless of injury severity, and found there were no differences in admission hemodynamics or hospital length of stay.Abstract:
BACKGROUND: A number of retrospective studies recently have been published concerning nonoperative management of minor liver injuries, with cumulative success rates greater than 95%. However, no prospective analysis that involves a large number of higher grade injuries has been reported. The current study was conducted to evaluate the safety of nonoperative management of blunt hepatic trauma in hemodynamically stable patients regardless of injury severity. METHODS: Over a 22-month period, patients with blunt hepatic injury were evaluated prospectively. Unstable patients underwent laparotomies, and stable patients had abdominal computed tomography (CT) scans. Those with nonhepatic operative indications underwent exploration, and the remainder were managed nonoperatively in the trauma intensive care unit. This group was compared with a hemodynamically matched operated cohort of blunt hepatic trauma patients (control subjects) who had been prospectively analyzed. RESULTS: One hundred thirty-six patients had blunt hepatic trauma. Twenty-four (18%) underwent emergent exploration. Of the remaining 112 patients, 12 (11%) failed observation and underwent celiotomy--5 were liver-related failures (5%) and 7 were nonliver related (6%). Liver related failure rates for CT grades I through V were 20%, 3%, 3%, 0%, and 12%, respectively, and rates according to hemoperitoneum were 2% for minimal, 6% for moderate, and 7% for large. The remaining 100 patients were successfully treated without operation--30% had minor injuries (grades I-II) and 70% had major (grades III-V) injuries. There were no differences in admission characteristics between nonoperative success or failures, except admission systolic blood pressure (127 vs. 104; p < 0.04). Comparing the nonoperative group to the control group, there were no differences in admission hemodynamics or hospital length of stay, but nonoperative patients had significantly fewer blood transfusions (1.9 vs. 4.0 units; p < 0.02) and fewer abdominal complications (3% vs. 11%; p < 0.04). CONCLUSIONS: Nonoperative management is safe for hemodynamically stable patients with blunt hepatic injury, regardless of injury severity. There are fewer abdominal complications and less transfusions when compared with a matched cohort of operated patients. Based on admission characteristics or CT scan, it is not possible to predict failures; therefore, intensive care unit monitoring is necessary.read more
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Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma.
Andrew B. Peitzman,Brian V. Heil,Louis Rivera,Michael B. Federle,Brian G. Harbrecht,Keith D. Clancy,Martin A. Croce,Blaine L. Enderson,John A. Morris,David V. Shatz,J. Wayne Meredith,Juan B. Ochoa,Samir M. Fakhry,James G. Cushman,Joseph P. Minei,Mary McCarthy,Fred A. Luchette,Ricard N. Townsend,Glenn Tinkoff,Ernest F. J. Block,Steven E. Ross,Eric R. Frykberg,Richard M. Bell,Frank E. Davis,Leonard J. Weireter,Michael B. Shapiro,G. Patrick Kealey,Fred Rogers,Larry M. Jones,John B. Cone,C. Michael Dunham,Clyde E. McAuley +31 more
TL;DR: Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum.
Journal ArticleDOI
Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients.
H. Pachter,M. Margaret Knudson,B Esrig,Steven E. Ross,David B. Hoyt,Thomas H. Cogbill,H Sherman,Thomas M. Scalea,Paul B. Harrison,Steven R. Shackford +9 more
TL;DR: Current data would suggest that 50 to 80% of all adult patients with blunt hepatic injuries are candidates for nonoperative management, irrespective of grade of injury or degree of hemoperitoneum, and thus merit constant re-evaluation and close observation in critical care units.
Journal ArticleDOI
Evolution in the management of hepatic trauma: a 25-year perspective.
J. David Richardson,Glen A. Franklin,James K. Lukan,Eddy H. Carrillo,David A. Spain,Frank B. Miller,Mark Wilson,Hiram C. Polk,Lewis M. Flint +8 more
TL;DR: The treatment and outcome of liver injuries have changed dramatically in 25 years and the death rates from both blunt and penetrating trauma have improved significantly through each successive decade of the study.
Journal ArticleDOI
Blunt Hepatic Injury: A Paradigm Shift From Operative to Nonoperative Management in the 1990s
Ajai K. Malhotra,Timothy C. Fabian,Martin A. Croce,Timothy J. Gavin,Kenneth A. Kudsk,Gayle Minard,F. Elizabeth Pritchard +6 more
TL;DR: There has been a paradigm shift in the management of hemodynamically stable patients with blunt hepatic trauma, and nonoperative management significantly improves outcomes over operative management in terms of decreased abdominal infections, decreased transfusions, and decreased lengths of hospital stay.
Journal ArticleDOI
Selective nonoperative management of penetrating abdominal solid organ injuries.
Demetrios Demetriades,Pantelis Hadjizacharia,Costas Constantinou,Carlos V.R. Brown,Kenji Inaba,Peter Rhee,Ali Salim +6 more
TL;DR: In the appropriate environment, selective nonoperative management of penetrating abdominal solid organ injuries has a high success rate and a low complication rate.
References
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Thomas H. Cogbill,Ernest E. Moore,Gregory J. Jurkovich,David V. Feliciano,John A. Morris,Peter Mucha +5 more
TL;DR: The experience of six regional trauma centers with severe hepatic trauma was reviewed to identify trends in management, mortality, and postoperative complications.
Journal ArticleDOI
Significant trends in the treatment of hepatic trauma. Experience with 411 injuries.
TL;DR: The combination of portal triad occlusion, finger fracture technique, and the use of a viable omental pack is a safe, reliable, and effective method of managing complex hepatic injuries (grade III to IV).
Journal ArticleDOI
Nonoperative management of blunt hepatic trauma: the exception or the rule?
TL;DR: To evaluate the role of nonoperative management in the treatment of blunt liver trauma, all victims of blunt hepatic trauma admitted to the authors' institution during a 36-month period under a protocol of nonoperatively management were examined.