Computed tomography in blunt hepatic trauma
K. A. Davis, J. M. Brody and W. G. Cioffi
Department of Surgery, Rhode Island Hospital and Brown University School of Medicine, Providence, Rhode Island, USA.
BACKGROUND: Nonoperative management of blunt hepatic injury in
hemodynamically stable trauma patients is now common. Recently, it has been
proposed that the finding of hepatic periportal tracking (PPT) of blood on
the initial computed tomographic (CT) scan is a sensitive marker of
significant hepatic and subhepatic injury that might militate against
nonoperative management. While CT scan is useful in diagnosing the injury,
the utility of follow-up CT scans has not been elucidated. DESIGN:
Retrospective chart review. SETTING: Regional trauma center. PATIENTS: The
records of 58 hemodynamically stable patients with blunt hepatic trauma
were reviewed and the following data recorded: age, outcome, Injury
Severity Score (ISS), operative intervention, and complications. Computed
tomographic scans were taken on admission and reviewed for the presence of
PPT. The timing and radiographic appearance of follow-up CT scans was also
recorded. RESULTS: Seventeen patients (29%) had radiographic evidence of
PPT while 41 patients (71%) did not. Age, ISS, injury grade, overall
success rate of nonoperative management, and incidence of complications
were not statistically significant between the two groups. In no instance
did a routine follow-up CT scan affect subsequent management of the
patient. CONCLUSIONS: The finding of PPT on the admission CT scan is not
clinically significant and does not preclude nonoperative management of
patients with blunt hepatic injury. Furthermore, routine follow-up CT scans
are not indicated, as treatment is not influenced by their results. Rather,
follow-up CT scans should be obtained as dictated by the patient's clinical
course. Extrapolation of these findings to all patients with blunt hepatic
trauma in the United States would result in considerable savings of health
care dollars, without negatively affecting patient care.
