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Observational Study
. 2025 Oct 1;282(4):580-591.
doi: 10.1097/SLA.0000000000006831. Epub 2025 Jul 7.

Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications: Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial

Lindsey L Perea  1 , Kelsey L Fletcher  2 , Madison E Morgan  1 , Allison G McNickle  3 , Douglas Fraser  3 , Martin Rosenthal  4 , Ethan Wang  4 , Anna Goldenberg  5 , Emily Hancin  5 , Alison A Smith  6 , Jack A Leoni  6 , Jonathan P Meizoso  7   8 , Christopher F O'Neil  7   8 , Matthew Noorbakhsh  9 , Khalid Almahmoud  10 , David Lapham  11 , Erica Sais  11 , Daniel Cullinane  12 , Carolyne Falank  12 , Adrian A Maung  13 , Bishwajit Bhattacharya  13 , Paul Bjordahl  14 , Jenny Guido  14 , Alexandra Dixon  15 , Amanda Carlson  15 , Pascal Udekwu  16 , Chloe Shell  16 , Jaroslaw W Bilaniuk  17 , Zoltan H Nemeth  17 , Christopher A Butts  18 , Julia Zorn  18 , Mentor Ahmeti  19 , Steven Briggs  19 , James M Haan  20 , Kelly Lightwine  20 , John Oh  2 , Gary Marshall  21 , Morgan Collom  21 , Richard Lewis  22 , Greggory Davis  22 , Asanthi Ratnasekera  23 , Oluwadara Okorafor  24 , Meaghan Broderick  25 , Rishi Kundi  25 , Thomas Muse  26 , Charmi Mehta  26 , Michael Collins  27 , Jeffrey Lawrence  27 , Lewis A Jacobson  28 , Jamie Williams  28 , Kaily Ewing  29 , Joel Narveson  29 , Mark Lieser  30 , Jill Streams  31 , Stephen Gadomski  31 , John D Berne  32 , Dalier Rodriguez Mederos  32 , Amanda L Teichman  33 , Rachel L Choron  33 , Jennifer Grant  34 , Nicole Frederick  34 , David Evans  35 , Stephanie Doris  35 , Dane Scantling  36 , Aksel Laudon  36 , Patrick Craft  37 , Jordan Kirsch  38 , William Brigode  39 , Johanna S Stecher  39 , Jeffry Nahmias  40 , Claudia Alvarez  40 , Vasileios Mousafeiris  41 , Francesk Mulita  41 , Morgan Turcotte  42 , Tyler Holliday  43 , Christopher P Michetti  43 , Nina Glass  44 , Alexandra Jackovich  44 , Brittany Bankhead  45 , Brevin Thompson  46 , Sharfuddin Chowdhury  47 , Brian Thurston  48 , Carolyn Bailey  48 , Kellie Bresz  49 , Michael Horst  49 , Andrew Bernard  42 , Joshua P Hazelton  50
Affiliations
Observational Study

Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications: Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial

Lindsey L Perea et al. Ann Surg. .

Abstract

Objective: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications.

Background: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate- to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition.

Methods: We performed a 4-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention.

Results: We identified 2341 BLI and 2143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822 (35.1%) BLI patients [SI: 457 (55.5%), CC: 365 (44.5%)] and 758 (27.9%) BSI patients [SI: 478 (63.1%), CC: 280 (37.0%)]. Complications were identified on repeat imaging in BLI: 167 (7.1%) [SI: 72 (43.1%), CC: 95 (56.9%)] and BSI: 203 (7.5%) [SI: 91 (44.8%), CC: 112 (55.2%)]. Of patients with BLI complications, 96 (57.8%) [SI: 37 (38.5%), CC: 59 (61.5%)] underwent an intervention. Of patients with BSI complications, 133 (65.5%) [SI: 56 (42.1%), CC: 77 (57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48 to 72 hours.

Conclusions: Scheduled repeat imaging for asymptomatic patients with BLI grade 4 to 5 and BSI grade 3 to 5 within 48 to 72 hours from time of diagnosis allows for identification of complications before a change in the patient's clinical condition.

Keywords: blunt liver injury; blunt spleen injury; delayed complications; nonoperative management; repeat imaging.

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Conflict of interest statement

There was no funding provided for this study from any sources. L.L.P. has a financial relationship with Haemonetics for research equipment supplied and an anticipated financial relationship Aroa Biosurgery- Primary investigator of prospective registry study (NCT05243966). A.A.S. has received honoraria from Prytime Medical (member on advisory council), and Aroa Biosurgery (consultant). J.P.M. has received research support, and travel lodging from Takeda Pharmaceuticals and CSL Behring, as well as honorarium from Cereus (speakers bureau). A.A.M. has received research support and serves on advisory committee for CSL Behring- Steering Committee for the CSL Behring Research Study - Evaluation of BE1116 (4-Factor Prothrombin Complex Concentrate [Kcentra®/Beriplex®] in Patients with Traumatic Injury and Acute Major Bleeding to Improve Survival (TAP Study). C.A.B. has received honorarium from Aroa Biosurgery (consultant). A.R. has received funding from ACCEL PILOT NIGMS/ NIH PI: U54 GM10494. L.A.J. has received research support and travel paid by CSL Behring. J.W. has received research support and travel paid by CSL Behring. R.L.C. has received research support from Rutgers Gun Violence Research Center – Award 2021 for unrelated research and Rutgers Office for the Vice Provost for Research (OVPR) Gun Violence Seed Grant 2023-2024: for unrelated research. Additionally, she has received grant funding from NIH NIGMS R43 Small Business Innovation Research Grant 2024: for unrelated research. D.E. has received honoraria from Abbott Nutrition (Consulting and Speaking) Alcresta Therapeutics (Consulting and Speaking) and Fresenius Kabi (Consulting and Speaking). D.S. (Faculty Research Scholarship), from NIH (L60 LRP) and from Stepping Strong. J.P.H. is the Chief Medical Officer of Beeken Biomedical, receives consulting fees from Sentinel Medical (on medical advisory board), consulting fees and stock options from Amsel Medical (medical advisory board), and from Infrascanner (medical advisory board). The remaining authors report no conflicts of interest.

References

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