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

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.