Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: A multicenter analysis

M. Gage Ochsner, Margaret M. Knudson, H. Leon Pachter, David B. Hoyt, Thomas H. Cogbill, Clyde E. McAuley, Frank E. Davis, Stan Rogers, Amber Guth, Joan Garcia, Pam Lambert, Norman Thomson, Scott J J Evans, Emil J. Balthazar, Giovanna Casola, Mark A. Nigogosyan, Richard Barr

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background: The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. Objective: The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. Methods: Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. Results: A total of 938 patients with liver and splenic injuries were identified. In this group, 11% of liver injuries and 12% of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28%) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97% of the injuries were managed nonoperatively. However, 8 patients (3%) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). Conclusion: Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5% associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury.

Original languageEnglish (US)
Pages (from-to)505-510
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number3
StatePublished - 2000

Fingerprint

Liver
Wounds and Injuries
Spleen
Hemorrhage
Peritoneal Lavage
Abdominal Injuries
Nonpenetrating Wounds
Trauma Centers
Demography
Incidence

Keywords

  • Blunt abdominal trauma
  • Computed tomographic scan
  • Diagnostic peritoneal lavage
  • Intraperitoneal fluid
  • Liver
  • Spleen
  • Ultrasound

ASJC Scopus subject areas

  • Surgery

Cite this

Ochsner, M. G., Knudson, M. M., Pachter, H. L., Hoyt, D. B., Cogbill, T. H., McAuley, C. E., ... Barr, R. (2000). Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: A multicenter analysis. Journal of Trauma - Injury, Infection and Critical Care, 49(3), 505-510.

Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries : A multicenter analysis. / Ochsner, M. Gage; Knudson, Margaret M.; Pachter, H. Leon; Hoyt, David B.; Cogbill, Thomas H.; McAuley, Clyde E.; Davis, Frank E.; Rogers, Stan; Guth, Amber; Garcia, Joan; Lambert, Pam; Thomson, Norman; Evans, Scott J J; Balthazar, Emil J.; Casola, Giovanna; Nigogosyan, Mark A.; Barr, Richard.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 3, 2000, p. 505-510.

Research output: Contribution to journalArticle

Ochsner, MG, Knudson, MM, Pachter, HL, Hoyt, DB, Cogbill, TH, McAuley, CE, Davis, FE, Rogers, S, Guth, A, Garcia, J, Lambert, P, Thomson, N, Evans, SJJ, Balthazar, EJ, Casola, G, Nigogosyan, MA & Barr, R 2000, 'Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: A multicenter analysis', Journal of Trauma - Injury, Infection and Critical Care, vol. 49, no. 3, pp. 505-510.
Ochsner, M. Gage ; Knudson, Margaret M. ; Pachter, H. Leon ; Hoyt, David B. ; Cogbill, Thomas H. ; McAuley, Clyde E. ; Davis, Frank E. ; Rogers, Stan ; Guth, Amber ; Garcia, Joan ; Lambert, Pam ; Thomson, Norman ; Evans, Scott J J ; Balthazar, Emil J. ; Casola, Giovanna ; Nigogosyan, Mark A. ; Barr, Richard. / Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries : A multicenter analysis. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 3. pp. 505-510.
@article{992782bda59a44ba8706d3021c6d8679,
title = "Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: A multicenter analysis",
abstract = "Background: The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. Objective: The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. Methods: Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. Results: A total of 938 patients with liver and splenic injuries were identified. In this group, 11{\%} of liver injuries and 12{\%} of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28{\%}) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97{\%} of the injuries were managed nonoperatively. However, 8 patients (3{\%}) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). Conclusion: Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5{\%} associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury.",
keywords = "Blunt abdominal trauma, Computed tomographic scan, Diagnostic peritoneal lavage, Intraperitoneal fluid, Liver, Spleen, Ultrasound",
author = "Ochsner, {M. Gage} and Knudson, {Margaret M.} and Pachter, {H. Leon} and Hoyt, {David B.} and Cogbill, {Thomas H.} and McAuley, {Clyde E.} and Davis, {Frank E.} and Stan Rogers and Amber Guth and Joan Garcia and Pam Lambert and Norman Thomson and Evans, {Scott J J} and Balthazar, {Emil J.} and Giovanna Casola and Nigogosyan, {Mark A.} and Richard Barr",
year = "2000",
language = "English (US)",
volume = "49",
pages = "505--510",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries

T2 - A multicenter analysis

AU - Ochsner, M. Gage

AU - Knudson, Margaret M.

AU - Pachter, H. Leon

AU - Hoyt, David B.

AU - Cogbill, Thomas H.

AU - McAuley, Clyde E.

AU - Davis, Frank E.

AU - Rogers, Stan

AU - Guth, Amber

AU - Garcia, Joan

AU - Lambert, Pam

AU - Thomson, Norman

AU - Evans, Scott J J

AU - Balthazar, Emil J.

AU - Casola, Giovanna

AU - Nigogosyan, Mark A.

AU - Barr, Richard

PY - 2000

Y1 - 2000

N2 - Background: The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. Objective: The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. Methods: Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. Results: A total of 938 patients with liver and splenic injuries were identified. In this group, 11% of liver injuries and 12% of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28%) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97% of the injuries were managed nonoperatively. However, 8 patients (3%) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). Conclusion: Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5% associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury.

AB - Background: The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. Objective: The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. Methods: Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. Results: A total of 938 patients with liver and splenic injuries were identified. In this group, 11% of liver injuries and 12% of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28%) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97% of the injuries were managed nonoperatively. However, 8 patients (3%) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). Conclusion: Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5% associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury.

KW - Blunt abdominal trauma

KW - Computed tomographic scan

KW - Diagnostic peritoneal lavage

KW - Intraperitoneal fluid

KW - Liver

KW - Spleen

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=0033775052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033775052&partnerID=8YFLogxK

M3 - Article

C2 - 11003330

AN - SCOPUS:0033775052

VL - 49

SP - 505

EP - 510

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -