T. Bongiovanni1, C. A. Wybourn1, B. Del Buono1, A. Mendoza1, R. Callcut1 1University Of California San Francisco,Surgery,San Francisco, CALIFORNIA, USA
Introduction:
Post-injury pseudoaneurysm formation is a potentially life threatening complication following hepatic trauma, however, the role of routine post-injury imaging surveillance is undefined. The aim of this study is to investigate if repeat CT imaging altered clinical practice for those suffering either blunt or penetrating hepatic trauma.
Methods:
A retrospective analysis of an urban level 1 trauma center surveillance registry was queried to identify all patients with hepatic trauma between September 2015 and December 2016. All patients with hepatic trauma that survived more than 24 hours were included. Grading of liver injury was done based on the AAST organ injury scale. A positive CT was defined as having a new pathologic finding. Invasive intervention was defined as operative management or angioembolization.
Results:
During the 16 month study period, 99 patients were treated for hepatic injury including 37 (37%) suffering penetrating injury. Mean age was 39, ISS was 22 and 77 were male. There were 15 (15%) grade 1 injuries, 42 (43%) grade 2, 18 (18%) grade 3, 19 (19%) grade 4, 5 (5%) grade 5. Median ICU length of stay was 3.5 days and total hospital length of stay was 6 days. Non-operative management was performed in 67 . Fifty-six of 99 patients did not have repeat imaging. The median time to repeat CT was 5 days. Repeat imaging changed management in 3/43 (7%) of those re-imaged, including in 3/19 (15.7%) suffering a Grade 4 injury. An addition patient had clinical signs of hemorrhage prior to a repeat CT scan and underwent angioembolization.
Conclusion:
This data suggests that routine follow up CT scan did not change management in those suffering low grade hepatic injuries and it may be safe to avoid radiation exposure for this patient group unless there is a change in clinical status. However, in those with Grade 4-5 injuries, post-injury imaging surveillance changed management in a significant percentage of patients. Further study is warranted to define the optimum timing of post-injury surveillance for these high grade injuries.