• Eur J Trauma Emerg Surg · May 2024

    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, and Junichi Sasaki.
    • Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, 160-8582, Tokyo, Japan. ryo.yamamoto@gmail.com.
    • Eur J Trauma Emerg Surg. 2024 May 23.

    PurposeWhile 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).MethodsA 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.ResultsAmong 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]).ConclusionFollow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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