Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: A WTA multicenter study
- PMID: 39443838
- DOI: 10.1097/TA.0000000000004372
Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: A WTA multicenter study
Abstract
Background: Prior studies evaluating observation versus angioembolization (AE) for blunt liver injuries (BLT) with contrast extravasation (CE) on computed tomography imaging have yielded inconsistent conclusions, primarily due to limitations in single-center and/or retrospective study design. Therefore, this multicenter study aims to compare an observation versus AE-first approach for BLT, hypothesizing decreased liver-related complications (LRCs) with observation.
Methods: We conducted a post hoc analysis of a multicenter, prospective observational study (2019-2021) across 23 centers. Adult patients with BLT + CE undergoing observation or AE within 8 hours of arrival were included. The primary outcome was LRCs, defined as perihepatic fluid collection, bile leak/biloma, pseudoaneurysm, hepatic necrosis, and/or hepatic abscess. A multivariable logistic regression analysis was used to evaluate risk factors associated with LRCs.
Results: From 128 patients presenting with BLT + CE on imaging, 71 (55.5%) underwent observation-first and 57 (45.5%) AE-first management. Both groups were comparable in age, vitals, mechanism of injury, and shock index (all p > 0.05), however the AE group had increased frequency of American Association for the Surgery of Trauma Grade IV injuries (51.0% vs. 22.0%, p = 0.002). The AE cohort demonstrated increased rates of in-hospital LRCs (36.8% vs. 12.7%, p = 0.038), emergency department representation (25.0% vs. 10.0%, p = 0.025), and hospital readmission for LRCs (12.3% vs. 1.4%, p = 0.012). However, the two cohorts had similar mortality rates (5.7% vs. 5.3%, p = 0.912). After adjusting for age, ISS, and grade of liver injury, an AE-first approach had a similar associated risk of LRCs compared with observation-first management (odds ratio, 1.949; 95% confidence interval, 0.673-5.643; p = 0.219).
Conclusion: Patients with blunt liver injury and CE undergoing an observation-first approach were associated with a similar adjusted risk of LRCs and rate of mortality compared with AE-first approach. Overall, this calls for reevaluation of the role of routine AE in blunt liver trauma patients with CE. Future prospective randomized trials are needed to confirm these findings.
Level of evidence: Therapeutic/Care Management, Level IV.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
References
-
- Taghavi S, Askari R. Liver Trauma . Treasure Island (FL): StatPearls; 2023.
-
- Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg . 2008;207(5):646–655.
-
- Alarhayem AQ, Myers JG, Dent D, Lamus D, Lopera J, Liao L, et al. “Blush at first sight”: significance of computed tomographic and angiographic discrepancy in patients with blunt abdominal trauma. Am J Surg . 2015;210(6):1104–1110 discussion 10-1.
-
- Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma . 2009;67(6):1144–1148 discussion 8-9.
-
- Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg . 2012;73(5 Suppl 4):S288–S293.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials