Nonoperative management is presently considered the treatment modality of choice in over 50% of adult patients sustaining blunt hepatic trauma who meet inclusion criteria. A multicenter study was retrospectively undertaken to assess whether the combined experiences at level I trauma centers could validate the currently reported high success rate, low morbidity, and virtually nonexistent mortality associated with this approach. Thirteen level I trauma centers accrued 404 adult patients sustaining blunt hepatic injuries managed nonoperatively over the last 5 years. Seventy-two percent of the injuries resulted from motor vehicle crashes. The mean injury severity score for the entire group was 20.2 (range, 4-75), and the American Association for the Surgery of Trauma-computerized axial tomography scan grading was as follows: grade I, 19% (n = 76); grade II, 31% (n = 124); grade III, 36% (n = 146); grade IV, 10% (n = 42); and grade V, 4% (n = 16). There were 27 deaths (7%) in the series, with 59% directly related to head trauma. Only two deaths (0.4%) could be attributed to hepatic injury. Twenty-one (5%) complications were documented, with the most common being hemorrhage, occurring in 14 (3.5%). Only 3 (0.7%) of these 14 patients required surgical intervention, 6 were treated by transfusions alone (0.5 to 5 U), 4 underwent angio-embolization, and 1 was further observed. Other complications included 2 bilomas and 3 perihepatic abscesses (all drained percutaneously). Two small bowel injuries were initially missed (0.5%), and diagnosed 2 and 3 days after admission. Overall, 6 patients required operative intervention: 3 for hemorrhage, 2 for missed enteric injuries, and 1 for persistent sepsis after unsuccessful percutaneous drainage. Average length of stay was 13 days. Nonoperative management of blunt hepatic injuries is clearly the treatment modality of choice in hemodynamically stable patients, irrespective of grade of injury or degree of hemoperitoneum. Current data would suggest that 50 to 80% (47% in this series) of all adult patients with blunt hepatic injuries are candidates for this form of therapy. Exactly 98.5% of patients analyzed in this study successfully avoided operative intervention. Bleeding complications are infrequently encountered (3.5%) and can often be managed nonoperatively. Although grades IV and V injuries composed 14% of the series, they represented 66.6% of the patients requiring operative intervention and thus merit constant re-evaluation and close observation in critical care units. The optimal time for follow-up computerized axial tomography scanning seems to be within 7 to 10 days after injury.

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Although personality has been documented in numerous animals and characters, research into personality-dependent spatial ecology has focused on dispersal. Indeed, few authors have investigated the role of other important spatial traits such as home range, movement distance, vertical activity, and site fidelity, and it is not clear whether these behaviors are correlated with dispersal. In this study, we investigated individual differences in home range, dispersal from release, vertical activity, movement distance, and site fidelity of 44 wild burbot Lota lota over 2 years, using an acoustic telemetry array and a Bayesian mixed modeling framework. We tested whether the spatial behaviors met the following criteria for personality-dependent behavior: repeatability, cross-contextual consistency, and an absence of pseudo-repeatability associated with spatial context choice. We then tested for between-individual correlations among spatial behaviors, indicative of a behavioral syndrome. Our results documented repeatable, cross-contextually consistent, personalitydependent home range, movement, dispersal from release, and site fidelity. In contrast, behavioral differences in vertical activity were inconsistent across sampling years and may have been a product of habitat heterogeneity. Our data indicate a spatial behavioral syndrome occurred independently from dispersal from release, with behavioral types ranging from "resident" individuals with small home ranges, high site fidelity, and minimal movement to "mobile" individuals with large home ranges, high movement rates, and little site fidelity. Our findings suggest animal personality can play a key role in shaping the space use of individuals, and this diversity in spatial behaviors may be too complex to be captured by often used simple linear measures of dispersal.

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