New Zealand Liver Transplant Unit, Auckland, New Zealand; Trauma Services, Auckland City Hospital, New Zealand.
Hepatobiliary Unit, Department of General Surgery, Auckland City Hospital, New Zealand.
Injury. 2022 Jan;53(1):86-91. doi: 10.1016/j.injury.2021.09.038. Epub 2021 Sep 28.
Surveillance imaging following liver trauma (LT) in asymptomatic patients is performed in many centers. Recent guidelines recommend follow-up imaging if there is a clinical indication.
To compare liver complications detected through surveillance versus selective imaging in patients following known LT.
A retrospective review of a prospective trauma registry was undertaken including all patients that presented with LT at a single center. All radiology images and reports of patients with LT were reviewed. The indication for follow-up imaging was ascertained by reviewing the radiology request and the patients' clinical record.
During the 14-year study, 450 patients were admitted with LT. Liver complications occurred in 50 patients (11%). Follow-up imaging was performed in 169 patients (38%). Of the patients having follow-up imaging, 92 patients had this for clinical deterioration, 55 had surveillance imaging and 22 had follow-up imaging for a non-liver indication. The majority of patients undergoing surveillance imaging had an AAST grade III-V injury (68%). None of the 55 patients having surveillance imaging had a liver complication. In contrast, 36 out of 92 patients having follow-up imaging for clinical deterioration had a complication within their liver (39%). There was a significantly higher incidence of complication detection for clinical deterioration versus surveillance imaging (p = < 0.0001).
Although complications following high-grade LT are common, they invariably cause clinical deterioration. There is no evidence for surveillance imaging following LT. Follow-up imaging should be guided by the patient's clinical condition.
许多中心对无症状肝外伤（LT）患者进行监测影像学检查。最近的指南建议如果有临床指征，则进行随访影像学检查。
比较已知 LT 患者监测与选择性影像学检查中发现的肝并发症。
对一个单中心前瞻性创伤登记处进行回顾性研究，包括所有 LT 患者。对所有 LT 患者的影像学图像和报告进行回顾。通过查看放射学请求和患者的临床记录来确定随访影像学检查的指征。
在 14 年的研究期间，450 名患者因 LT 入院。50 名患者（11%）发生肝并发症。169 名患者（38%）进行了随访影像学检查。在进行随访影像学检查的患者中，92 名患者因临床恶化进行检查，55 名患者进行了监测影像学检查，22 名患者因非肝脏原因进行了随访影像学检查。进行监测影像学检查的大多数患者的 AAST 分级为 III-V 级（68%）。55 名进行监测影像学检查的患者中无一例发生肝并发症。相比之下，92 名因临床恶化而进行随访影像学检查的患者中有 36 名（39%）在其肝脏中出现并发症。与监测影像学检查相比，临床恶化时并发症的检出率显著更高（p<0.0001）。
尽管高等级 LT 后并发症很常见，但它们总是会导致临床恶化。LT 后无监测影像学检查的证据。随访影像学检查应根据患者的临床状况进行指导。
