COMPUTED-TOMOGRAPHY IN BLUNT HEPATIC-TRAUMA

Background: Nonoperative management of blunt hepatic injury in hemodyn amically stable trauma patients is now common. Recently, it has been p roposed that the finding of hepatic periportal tracking (PPT) of blood on the initial computed tomographic (CT) scan is a sensitive marker o f significant hepatic and subhepatic injury that might militate agains t nonoperative management. While CT scan is useful in diagnosing the i njury, the utility of follow-up CT scans has not been elucidated. Desi gn: Retrospective chart review. Setting: Regional trauma center. Patie nts: The records of 58 hemodynamically stable patients with blunt hepa tic trauma were reviewed and the following data recorded: age, outcome , Injury Severity Score (ISS), operative intervention, and complicatio ns. Computed tomographic scans were taken on admission and reviewed fo r the presence of PPT. The timing and radiographic appearance of follo w-up CT scans was also recorded. Results: Seventeen patients (29%) had radiographic evidence of PPT while 41 patients (71%) did not. Age, IS S, injury grade, overall success rate of nonoperative management, and incidence of complications were not statistically significant between the two groups. In no instance did a routine follow-up CT scan affect subsequent management of the patient. Conclusions: The finding of PPT on the admission CT scan is not clinically significant and does not pr eclude nonoperative management of patients with blunt hepatic injury. Furthermore, routine follow-up CT scans are not indicated, as treatmen t is not influenced by their results. Rather, follow-up CT scans shoul d be obtained as dictated by the patient's clinical course. Extrapolat ion of these findings to all patients with blunt hepatic trauma in the United States would result in considerable savings of health care dol lars, without negatively affecting patient care.