Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury

Yi Chieh Huang, Shih Chi Wu, Chih Yuan Fu, Yung Fang Chen, Ray Jade Chen, Chi Hsun Hsieh, Yu-Chun Wang, Hung Chang Huang, Jui Chien Huang, Chih Wei Lu

研究成果: 雜誌貢獻文章

12 引文 (Scopus)

摘要

Background: Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan. Methods: From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success. Results: A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma. Conclusions: Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.
原文英語
頁(從 - 到)448-453
頁數6
期刊American Journal of Surgery
203
發行號4
DOIs
出版狀態已發佈 - 四月 2012

指紋

Nonpenetrating Wounds
Liver
Peritoneum
Injury Severity Score
Tomography
Blood Transfusion
Wounds and Injuries
Hemostatics

ASJC Scopus subject areas

  • Surgery

引用此文

Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury. / Huang, Yi Chieh; Wu, Shih Chi; Fu, Chih Yuan; Chen, Yung Fang; Chen, Ray Jade; Hsieh, Chi Hsun; Wang, Yu-Chun; Huang, Hung Chang; Huang, Jui Chien; Lu, Chih Wei.

於: American Journal of Surgery, 卷 203, 編號 4, 04.2012, p. 448-453.

研究成果: 雜誌貢獻文章

Huang, YC, Wu, SC, Fu, CY, Chen, YF, Chen, RJ, Hsieh, CH, Wang, Y-C, Huang, HC, Huang, JC & Lu, CW 2012, 'Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury', American Journal of Surgery, 卷 203, 編號 4, 頁 448-453. https://doi.org/10.1016/j.amjsurg.2011.01.031
Huang, Yi Chieh ; Wu, Shih Chi ; Fu, Chih Yuan ; Chen, Yung Fang ; Chen, Ray Jade ; Hsieh, Chi Hsun ; Wang, Yu-Chun ; Huang, Hung Chang ; Huang, Jui Chien ; Lu, Chih Wei. / Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury. 於: American Journal of Surgery. 2012 ; 卷 203, 編號 4. 頁 448-453.
@article{6b5a519fdbf94d25b9bf5cf6308a02f1,
title = "Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury",
abstract = "Background: Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan. Methods: From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success. Results: A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma. Conclusions: Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.",
keywords = "Angioembolization, Blunt hepatic injury, Contrast extravasation, Nonoperative management",
author = "Huang, {Yi Chieh} and Wu, {Shih Chi} and Fu, {Chih Yuan} and Chen, {Yung Fang} and Chen, {Ray Jade} and Hsieh, {Chi Hsun} and Yu-Chun Wang and Huang, {Hung Chang} and Huang, {Jui Chien} and Lu, {Chih Wei}",
year = "2012",
month = "4",
doi = "10.1016/j.amjsurg.2011.01.031",
language = "English",
volume = "203",
pages = "448--453",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury

AU - Huang, Yi Chieh

AU - Wu, Shih Chi

AU - Fu, Chih Yuan

AU - Chen, Yung Fang

AU - Chen, Ray Jade

AU - Hsieh, Chi Hsun

AU - Wang, Yu-Chun

AU - Huang, Hung Chang

AU - Huang, Jui Chien

AU - Lu, Chih Wei

PY - 2012/4

Y1 - 2012/4

N2 - Background: Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan. Methods: From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success. Results: A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma. Conclusions: Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.

AB - Background: Nonoperative management (NOM) has become the standard treatment of blunt hepatic injury (BHI) for stable patients. Contrast extravasation (CE) on computed tomography (CT) scan had been reported as a sign that is associated with NOM failure. The goal of this study was to further investigate the risk factors of NOM failure in patients with CE on CT scan. Methods: From January 2005 to September 2009, patients with CE noted on a CT scan as a result of BHI were studied retrospectively. Physiological parameters, severity of injury, amount of transfusion, type of contrast extravasation, as well as treatment outcome were compared between patients with NOM failure and NOM success. Results: A total of 130 patients were enrolled. Injury severity scores, amount of blood transfusion before hemostatic procedure, and grade of liver injury were significantly higher in NOM failure than in NOM success patients. There was no statistical difference in the NOM success rate between patients with contrast leakage into the peritoneum and those with contrast confined in the hepatic parenchyma. Conclusions: Higher injury severity score, more blood transfusion, and higher grade of liver injury are factors that correlate with NOM failure in patients with BHI. Contrast leakage into the peritoneum is not always a definite sign of NOM failure in BHI. Early and aggressive angioembolization is an effective adjunct of NOM in BHI patients, even with contrast leakage into peritoneum.

KW - Angioembolization

KW - Blunt hepatic injury

KW - Contrast extravasation

KW - Nonoperative management

UR - http://www.scopus.com/inward/record.url?scp=84859111463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859111463&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2011.01.031

DO - 10.1016/j.amjsurg.2011.01.031

M3 - Article

C2 - 21794849

AN - SCOPUS:84859111463

VL - 203

SP - 448

EP - 453

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 4

ER -