Nonoperative management of blunt hepatic injury: An eastern association for the surgery of trauma practice management guideline

Nicole A. Stassen, Indermeet Bhullar, Julius D. Cheng, Marie Crandall, Randall S Friese, Oscar Guillamondegui, Randeep Jawa, Adrian Maung, Thomas J. Rohs, Ayodele Sangosanya, Kevin Schuster, Mark Seamon, Kathryn M. Tchorz, Ben L. Zarzuar, Andrew Kerwin

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

BACKGROUND: During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. METHODS: The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. RESULTS: One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. CONCLUSION: Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number5 SUPPL.4
DOIs
StatePublished - Nov 2012

Fingerprint

Nonpenetrating Wounds
Practice Management
Practice Guidelines
Liver
Wounds and Injuries
Guidelines
National Library of Medicine (U.S.)
Abdominal Injuries
Explosions
Endoscopic Retrograde Cholangiopancreatography
National Institutes of Health (U.S.)
Operating Rooms
Peritonitis
PubMed
MEDLINE
Laparoscopy
Laparotomy
Endoscopy
Drainage
Angiography

Keywords

  • blunt abdominal trauma
  • Guideline
  • hepatic
  • liver
  • surgery.

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Nonoperative management of blunt hepatic injury : An eastern association for the surgery of trauma practice management guideline. / Stassen, Nicole A.; Bhullar, Indermeet; Cheng, Julius D.; Crandall, Marie; Friese, Randall S; Guillamondegui, Oscar; Jawa, Randeep; Maung, Adrian; Rohs, Thomas J.; Sangosanya, Ayodele; Schuster, Kevin; Seamon, Mark; Tchorz, Kathryn M.; Zarzuar, Ben L.; Kerwin, Andrew.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 5 SUPPL.4, 11.2012.

Research output: Contribution to journalArticle

Stassen, NA, Bhullar, I, Cheng, JD, Crandall, M, Friese, RS, Guillamondegui, O, Jawa, R, Maung, A, Rohs, TJ, Sangosanya, A, Schuster, K, Seamon, M, Tchorz, KM, Zarzuar, BL & Kerwin, A 2012, 'Nonoperative management of blunt hepatic injury: An eastern association for the surgery of trauma practice management guideline', Journal of Trauma and Acute Care Surgery, vol. 73, no. 5 SUPPL.4. https://doi.org/10.1097/TA.0b013e318270160d
Stassen, Nicole A. ; Bhullar, Indermeet ; Cheng, Julius D. ; Crandall, Marie ; Friese, Randall S ; Guillamondegui, Oscar ; Jawa, Randeep ; Maung, Adrian ; Rohs, Thomas J. ; Sangosanya, Ayodele ; Schuster, Kevin ; Seamon, Mark ; Tchorz, Kathryn M. ; Zarzuar, Ben L. ; Kerwin, Andrew. / Nonoperative management of blunt hepatic injury : An eastern association for the surgery of trauma practice management guideline. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 5 SUPPL.4.
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abstract = "BACKGROUND: During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. METHODS: The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. RESULTS: One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. CONCLUSION: Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.",
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AU - Cheng, Julius D.

AU - Crandall, Marie

AU - Friese, Randall S

AU - Guillamondegui, Oscar

AU - Jawa, Randeep

AU - Maung, Adrian

AU - Rohs, Thomas J.

AU - Sangosanya, Ayodele

AU - Schuster, Kevin

AU - Seamon, Mark

AU - Tchorz, Kathryn M.

AU - Zarzuar, Ben L.

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N2 - BACKGROUND: During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline. METHODS: The National Library of Medicine and the National Institutes of Health MEDLINE database were searched using PubMed (http://www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords liver injury and blunt abdominal trauma. RESULTS: One hundred seventy-six articles were reviewed, of which 94 were used to create the current practice management guideline for the selective nonoperative management of blunt hepatic injury. CONCLUSION: Most original hepatic guidelines remained valid and were incorporated into the greatly expanded current guidelines as appropriate. Nonoperative management of blunt hepatic injuries currently is the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury or patient age. Nonoperative management of blunt hepatic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention. Intravenous contrast enhanced computed tomographic scan is the diagnostic modality of choice for evaluating blunt hepatic injuries. Repeated imaging should be guided by a patient's clinical status. Adjunctive therapies like angiography, percutaneous drainage, endoscopy/endoscopic retrograde cholangiopancreatography and laparoscopy remain important adjuncts to nonoperative management of hepatic injuries. Despite the explosion of literature on this topic, many questions regarding nonoperative management of blunt hepatic injuries remain without conclusive answers in the literature.

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