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, Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA.
Kelsey L. Fletcher, Department of Surgery, Penn State Health, Hershey, PA.
Madison E. Morgan, Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA.
Allison G. McNickle, Department of Surgery, University of Nevada, Las Vegas, NV.
Douglas Fraser, Department of Surgery, University of Nevada, Las Vegas, NV.
Martin Rosenthal, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA.
Ethan Wang, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA.
Anna Goldenberg, Department of Surgery, Cooper University Hospital, Camden, NJ.
Emily Hancin, Department of Surgery, Cooper University Hospital, Camden, NJ.
Alison A. Smith, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Jack A. Leoni, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Jonathan P. Meizoso, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
Christopher F. O'Neil, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL.
Matthew Noorbakhsh, Department of Surgery, University of Virginia, Charlottesville, VA.
Khalid Almahmoud, Department of Surgery, Allegheny General Hospital, Pittsburgh, PA.
David Lapham, Department of Surgery, Jefferson University, Philadelphia, PA.
Erica Sais, Department of Surgery, Jefferson University, Philadelphia, PA.
Daniel Cullinane, Department of Surgery, Maine Medical Center, Portland, ME.
Carolyne Falank, Department of Surgery, Maine Medical Center, Portland, ME.
Adrian A. Maung, Department of Surgery, Yale New Haven Hospital, New Haven, CT.
Bishwajit Bhattacharya, Department of Surgery, Yale New Haven Hospital, New Haven, CT.
Paul Bjordahl, Department of Surgery, Sanford USD Medical Center Sioux Falls, Sioux Falls, SD.
Jenny Guido, Department of Surgery, Sanford USD Medical Center Sioux Falls, Sioux Falls, SD.
Alexandra Dixon, Department of Surgery, Legacy Emanuel Medical Center, Portland, OR.
Amanda Carlson, Department of Surgery, Legacy Emanuel Medical Center, Portland, OR.
Pascal Udekwu, Department of Surgery, Wake Med Health and Hospitals, Raleigh, NC.
Chloe Shell, Department of Surgery, Wake Med Health and Hospitals, Raleigh, NC.
Jaroslaw W. Bilaniuk, Department of Surgery, Atlantic Health Morristown Medical Center, Morristown, NJ.
Zoltan H. Nemeth, Department of Surgery, Atlantic Health Morristown Medical Center, Morristown, NJ.
Christopher A. Butts, Department of Surgery, Tower Health Reading Hospital, Reading, PA.
Julia Zorn, Department of Surgery, Tower Health Reading Hospital, Reading, PA.
Mentor Ahmeti, Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, ND.

Document Type

Article

Publication Date

10-1-2025

Journal Title

Annals of surgery

MeSH Headings

Humans; Wounds, Nonpenetrating (diagnostic imaging, complications, therapy); Spleen (injuries, diagnostic imaging); Male; Female; Prospective Studies; Middle Aged; Adult; Liver (injuries, diagnostic imaging); Tomography, X-Ray Computed; Abdominal Injuries (diagnostic imaging, complications, therapy); Injury Severity Score; Aged

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.

First Page

580

Last Page

591

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