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Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center

BACKGROUND: The liberal utilization of computed tomography (CT) has significantly contributed to overall improvements in trauma care. However, the role and the current practice of the CT examinations in the management of patients with penetrating liver injuries are scantily documented. AIMS: This st...

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Autores principales: Schnüriger, Beat, Talving, Peep, Barbarino, Raffaella, Barmparas, Galinos, Inaba, Kenji, Demetriades, Demetrios
Formato: Texto
Lenguaje:English
Publicado: Medknow Publications 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097581/
https://www.ncbi.nlm.nih.gov/pubmed/21633569
http://dx.doi.org/10.4103/0974-2700.76838
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author Schnüriger, Beat
Talving, Peep
Barbarino, Raffaella
Barmparas, Galinos
Inaba, Kenji
Demetriades, Demetrios
author_facet Schnüriger, Beat
Talving, Peep
Barbarino, Raffaella
Barmparas, Galinos
Inaba, Kenji
Demetriades, Demetrios
author_sort Schnüriger, Beat
collection PubMed
description BACKGROUND: The liberal utilization of computed tomography (CT) has significantly contributed to overall improvements in trauma care. However, the role and the current practice of the CT examinations in the management of patients with penetrating liver injuries are scantily documented. AIMS: This study was aimed to assess the current practice and the role of the admission and follow-up CT in patients with penetrating liver injuries. SETTING AND DESIGN: This is a retrospective study at a Level I trauma center. Study period is from 01/2005 to 12/2007. METHODS: All patients with penetrating liver injuries were analyzed. RESULTS: Overall, 178 patients with penetrating liver injuries were assessed. A total of 123 (69.1%) patients underwent emergent laparotomy without preoperative CT due to signs of peritonitis (47.8%), hypotension (16.3%), or a GCS of ≤8 (5.1%). In this group of patients, no nontherapeutic laparotomy occurred. The remaining 55 (30.9%) patients underwent CT scan evaluation on admission. Of these, 54.5% were selected for nonoperative management (NOM). Sensitivity and specificity of the admission CT to predict a positive laparotomy was 95.7% and 90.6%, respectively. Overall, 80.6% of isolated liver injuries were successfully managed nonoperatively. Thirty-three (18.5%) patients died within 72 h. In the remaining 145 patients, 33 liver-related complications occurred in 17.2% (25 of 145) of patients. CONCLUSION: Two-thirds of patients with penetrating liver injuries require emergent laparotomy, mainly due to associated injuries. The remaining one-third of patients, however, is amenable for an admission CT, which reliably predicts successful NOM. Moderate or severe injuries require follow-up CT because of the high incidence of asymptomatic liver-related complications.
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spelling pubmed-30975812011-06-01 Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center Schnüriger, Beat Talving, Peep Barbarino, Raffaella Barmparas, Galinos Inaba, Kenji Demetriades, Demetrios J Emerg Trauma Shock Original Article BACKGROUND: The liberal utilization of computed tomography (CT) has significantly contributed to overall improvements in trauma care. However, the role and the current practice of the CT examinations in the management of patients with penetrating liver injuries are scantily documented. AIMS: This study was aimed to assess the current practice and the role of the admission and follow-up CT in patients with penetrating liver injuries. SETTING AND DESIGN: This is a retrospective study at a Level I trauma center. Study period is from 01/2005 to 12/2007. METHODS: All patients with penetrating liver injuries were analyzed. RESULTS: Overall, 178 patients with penetrating liver injuries were assessed. A total of 123 (69.1%) patients underwent emergent laparotomy without preoperative CT due to signs of peritonitis (47.8%), hypotension (16.3%), or a GCS of ≤8 (5.1%). In this group of patients, no nontherapeutic laparotomy occurred. The remaining 55 (30.9%) patients underwent CT scan evaluation on admission. Of these, 54.5% were selected for nonoperative management (NOM). Sensitivity and specificity of the admission CT to predict a positive laparotomy was 95.7% and 90.6%, respectively. Overall, 80.6% of isolated liver injuries were successfully managed nonoperatively. Thirty-three (18.5%) patients died within 72 h. In the remaining 145 patients, 33 liver-related complications occurred in 17.2% (25 of 145) of patients. CONCLUSION: Two-thirds of patients with penetrating liver injuries require emergent laparotomy, mainly due to associated injuries. The remaining one-third of patients, however, is amenable for an admission CT, which reliably predicts successful NOM. Moderate or severe injuries require follow-up CT because of the high incidence of asymptomatic liver-related complications. Medknow Publications 2011 /pmc/articles/PMC3097581/ /pubmed/21633569 http://dx.doi.org/10.4103/0974-2700.76838 Text en © Journal of Emergencies, Trauma, and Shock http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Schnüriger, Beat
Talving, Peep
Barbarino, Raffaella
Barmparas, Galinos
Inaba, Kenji
Demetriades, Demetrios
Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title_full Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title_fullStr Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title_full_unstemmed Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title_short Current practice and the role of the CT in the management of penetrating liver injuries at a Level I trauma center
title_sort current practice and the role of the ct in the management of penetrating liver injuries at a level i trauma center
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097581/
https://www.ncbi.nlm.nih.gov/pubmed/21633569
http://dx.doi.org/10.4103/0974-2700.76838
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