Observation for Nonoperative Management of Blunt Liver Injuries: How Long Is Long Enough?

Parks, Nancy A.; Davis, James W.; Forman, Dana; Lemaster, Deborah

doi:10.1097/ta.0b013e31820d1c69

Cited by 40 publications

(44 citation statements)

References 16 publications

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“…Liver-specific complication rate is 10%. In many studies, nonoperative management failure rate is under 10% (13). Similarly, in our series hemodynamically stable patients with grade 4 injuries were treated non-operatively with success (Figure 1, 2).…”

Section: Discussionmentioning

confidence: 64%

“…In a study where CT findings in blunt abdominal trauma were compared with surgery results (n=78) the sensitivity of CT in detecting hollow organ injuries was 55.3% and the specificity was 92% (14). That is why imaging should be used to support clinical findings, during follow up of hollow organ injuries in abdominal trauma and surgical decisionmaking (13).…”

Section: Discussionmentioning

confidence: 99%

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The conservative management of abdominal injuries

Okuş

Sevinç

et al. 2014

UCD

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Objective: Non-operative management of abdominal injuries has recently become more common. Especially nonoperative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of nonoperative treatment in abdominal trauma (blunt penetrating) is discussed. Material and Methods:All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. Results:The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. Conclusion:Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The conservative management of abdominal injuries

Okuş

Sevinç

et al. 2014

UCD

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“…1) [22][23][24]. The reported success rates for nonoperative management of liver injury are generally greater than 85 % [22,[25][26][27][28][29][30][31]. Approximately 70-80 % of liver injuries can be safely managed nonoperatively; even in most of the severe injuries, the nonoperative management rate approaches 50 % [32][33][34].…”

Section: Nonoperative Managementmentioning

confidence: 99%

Management of blunt liver injury: what is new?

Ward

Alarcon

2015

Eur J Trauma Emerg Surg

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Nonoperative management has become the surgical treatment of choice in the hemodynamically stable patient with blunt hepatic trauma. The increased use and success of nonoperative management have been facilitated by the development of increasingly higher resolution computed tomography imaging, improved management of physiology and resuscitation (damage control), and routine availability of interventional procedures such as angiography and embolization, image-guided percutaneous drainage, and endoscopy. On the other hand, recognition of the patient who should proceed to immediate laparotomy is of utmost importance. A systematic and logical approach to the control of hemorrhage is required in the operating room. Thorough knowledge of the anatomy and surgical techniques, such as perihepatic packing, effective Pringle maneuver, hepatic mobilization, infrahepatic and suprahepatic control of the IVC, and stapled hepatectomy, is essential.

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“…NOM of haemodynamically stable patients with a CT proven liver injury has a success rate of approximately 90% [57][58][59] and has reduced mortality in recent years. 60 Predictors of NOM failure include high-grade liver injuries and pooling of contrast 43 although a study by Velmahos et al revealed that only 2% of NOM failures were related to liver injury, reflecting a multiply injured patient group.…”

Section: Hepatic Injuriesmentioning

confidence: 99%

“…58 Parks et al identified 1.9 days as the average stay for successful NOM across all injury grades. 59 They concluded that haemodynamic status, physical examination and serial haemoglobin measurements can determine discharge safely as failures for haemorrhage occurred early and other failures developed in multiply injured inpatients. NOM is, however, not risk free.…”

Section: Hepatic Injuriesmentioning

confidence: 99%

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

Sharrock

Midwinter

2013

annals

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INTRODUCTION Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. METHODS The Ovid MEDLINE ®, EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. FINDINGS A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome.

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Observation for Nonoperative Management of Blunt Liver Injuries: How Long Is Long Enough?

Cited by 40 publications

References 16 publications

The conservative management of abdominal injuries

The conservative management of abdominal injuries

Management of blunt liver injury: what is new?

Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

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