Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury

Ryo Yamamoto, Yukio Sato, Ramon F. Cestero, Brian J. Eastridge, Katsuya Maeshima, Morihiro Katsura, Yutaka Kondo, Hideto Yasuda, Shigeki Kushimoto, Junichi Sasaki

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). Methods: A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008–2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Results: Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62–3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32–5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04–2.87]). Conclusion: Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

Original languageEnglish (US)
Pages (from-to)3115-3124
Number of pages10
JournalEuropean Journal of Trauma and Emergency Surgery
Volume50
Issue number6
DOIs
StatePublished - Dec 2024

Keywords

  • Angioembolization
  • Angiography
  • Blunt trauma
  • Early CT
  • Pseudoaneurysm rupture

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

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