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Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

BACKGROUND: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector comput...

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Autores principales: van der Vlies, Cornelis H, Olthof, Dominique C, Gaakeer, Menno, Ponsen, Kees J, van Delden, Otto M, Goslings, J Carel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170179/
https://www.ncbi.nlm.nih.gov/pubmed/21794108
http://dx.doi.org/10.1186/1865-1380-4-47
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author van der Vlies, Cornelis H
Olthof, Dominique C
Gaakeer, Menno
Ponsen, Kees J
van Delden, Otto M
Goslings, J Carel
author_facet van der Vlies, Cornelis H
Olthof, Dominique C
Gaakeer, Menno
Ponsen, Kees J
van Delden, Otto M
Goslings, J Carel
author_sort van der Vlies, Cornelis H
collection PubMed
description BACKGROUND: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. AIM: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. RESULTS: The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey. CONCLUSIONS: The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the success rate to 95%. However, to date many controversies exist about the optimum patient selection for NOM, the proper role of angioembolization in NOM, the best technique and material to use in angioembolization, and the right follow-up strategy of patients sustaining blunt abdominal injury. Conducting a well-designed prospective clinical trial or a Delphi study would be preferable.
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spelling pubmed-31701792011-09-12 Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs van der Vlies, Cornelis H Olthof, Dominique C Gaakeer, Menno Ponsen, Kees J van Delden, Otto M Goslings, J Carel Int J Emerg Med Review BACKGROUND: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. AIM: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. RESULTS: The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey. CONCLUSIONS: The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the success rate to 95%. However, to date many controversies exist about the optimum patient selection for NOM, the proper role of angioembolization in NOM, the best technique and material to use in angioembolization, and the right follow-up strategy of patients sustaining blunt abdominal injury. Conducting a well-designed prospective clinical trial or a Delphi study would be preferable. Springer 2011-07-27 /pmc/articles/PMC3170179/ /pubmed/21794108 http://dx.doi.org/10.1186/1865-1380-4-47 Text en Copyright ©2011 van der Vlies et al; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
van der Vlies, Cornelis H
Olthof, Dominique C
Gaakeer, Menno
Ponsen, Kees J
van Delden, Otto M
Goslings, J Carel
Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title_full Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title_fullStr Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title_full_unstemmed Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title_short Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
title_sort changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170179/
https://www.ncbi.nlm.nih.gov/pubmed/21794108
http://dx.doi.org/10.1186/1865-1380-4-47
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