LIMITED VALUE OF ROUTINE FOLLOW-UP CT SCANS IN NONOPERATIVE MANAGEMENT OF BLUNT LIVER AND SPLENIC INJURIES

The objective was to determine the utility of a second CT scan in nono perative management of blunt liver and splenic trauma. The design was a retrospective review of consecutive cases over a 2-year period in tw o trauma centers. Subjects were 152 patients with blunt abdominal trau ma and isolated injuries to liver and/or spleen. Thirty patients recei ved immediate laparotomy, whereas 122 patients (80%) underwent CT scan ning that showed splenic (n = 64), liver (n = 44), or combined (n = 14 ) injuries. Nonoperative management was undertaken in 99 of the 122 (8 1% of the patients who received CT scans; 65% of the overall series) a nd was ultimately successful in 94 (95%). Second CT scans were used in 26 patients (26%), one of whom received laparotomy for drainage of a bile leak and three for ongoing bleeding. None of the followup scans s howed major progression of injury, and scan findings did not influence decisions for operation in any patients. Routine followup CT scanning is not a justifiable component of nonoperative management protocols f or blunt liver and splenic injuries.