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Clinical Analysis of the Utility of Repeat Computed Tomographic Scan before Discharge in Blunt Hepatic Injury

Ciraulo, David L. DO; Nikkanen, Heikki E. BA, AS; Palter, Marc MD; Markowitz, Stuart MD; Gabram, Sheryl MD, FACS; Cowell, Vernon MD; Luk, Stephen MD; Jacobs, Lenworth MD, FACS, MPH

Journal of Trauma and Acute Care Surgery: November 1996 - Volume 41 - Issue 5 - p 821-824

Objectives  Nonoperative management of hemodynamically stable blunt hepatic injury has emerged as an acceptable and safe treatment. Surveillance of this population's injuries is costly. As a prelude to establishing practice guidelines, the utility of repeat computed tomographic (CT) scans was investigated.

Methods  A retrospective study was conducted on 243 hepatic injuries. The CT scans of 95 patients managed nonoperatively who did not have ongoing transfusion requirements were reviewed and graded according to the American Association for the Surgery of Trauma (AAST) hepatic injury scale. Patients were grouped according to injury grade, assigned to two subgroups (patients with one CT scan versus more than one CT scan) and compared with respect to several physiologic and clinical variables.

Results  Statistical analysis revealed no significant difference between subgroups with the same grade of injury. No significant difference was demonstrated between subgroups' length of stay.

Conclusions  No patients failed nonoperative treatment or succumbed to their injuries. Findings on repeat CT scan have not altered the decision to discharge the clinically stable patient having suffered a grade III or lower liver injury.

From the Department of Trauma/EMS and the Department of Radiology (S.M.), Hartford Hospital, Hartford, Connecticut.

Presented at the 9th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 10-13, 1996, Orlando, Florida.

Address for reprints: David L. Ciraulo, DO, Hartford Hospital, Dept. of Trauma/EMS, 80 Seymour Street, P.O. Box 5037, Hartford, CT 06102-5037.

© Williams & Wilkins 1996. All Rights Reserved.