Universität zu Köln

Boese, Christoph Kolja, Hackl, Michael ORCID: 0000-0002-6183-5621, Mueller, Lars Peter, Ruchholtz, Steffen, Frink, Michael and Lechler, Philipp (2015). Nonoperative management of blunt hepatic trauma: A systematic review. J. Trauma Acute Care Surg., 79 (4). S. 654 - 661. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 2163-0763

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Abstract

BACKGROUND Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma. METHODS Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials. RESULTS We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p < 0.05), fluid resuscitation (p = 0.02), blood transfusion (p = 0.003), peritoneal signs (p < 0.0001), Injury Severity Score (ISS) (p = 0.03), and associated intra-abdominal injuries (p < 0.01). CONCLUSION There is evidence that patients presenting with clinical signs of shock, a high ISS, associated intra-abdominal injuries, and peritoneal signs are at an increased risk of failure of NOM for the treatment of blunt hepatic injuries. LEVEL OF EVIDENCE Systematic review, level III.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Boese, Christoph Kolja UNSPECIFIED UNSPECIFIED UNSPECIFIED Hackl, Michael UNSPECIFIED orcid.org/0000-0002-6183-5621 UNSPECIFIED Mueller, Lars Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruchholtz, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Frink, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Lechler, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-391570
DOI:	10.1097/TA.0000000000000814
Journal or Publication Title:	J. Trauma Acute Care Surg.
Volume:	79
Number:	4
Page Range:	S. 654 - 661
Date:	2015
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	2163-0763
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LIVER-INJURIES; ORGAN INJURY; RESUSCITATION; METAANALYSIS; FAILURE Multiple languages Critical Care Medicine; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39157