Observation for nonoperative management of blunt liver injuries: how long is long enough?

Nonoperative management (NOM) of blunt liver injury is the standard of care in hemodynamically stable patients. However, there are no data regarding the optimum length of inpatient observation. The purpose of this study is to review NOM guidelines for patient safety and optimal length of stay (LOS).

A retrospective review of the trauma registry at a Level I trauma center was performed to identify all patients admitted with blunt liver injuries. Guidelines for length of observation were developed, such that patients were discharged with normal physical examination and stable hemoglobin, regardless of grade of injury. Data collected include injury severity score, grade of liver injury, LOS, success rate of NOM, time to failure of NOM, and reason for failure of NOM.

From August 2002 to March 2009, 591 patients were admitted for NOM of blunt liver injuries. Of these, 35 patients (6%) failed NOM; 19 failed secondary to hemorrhage, mostly from associated injuries. Average LOS for patients with isolated liver injuries was 2.2 days. Only one patient failed NOM as an outpatient. There were no adverse outcomes from these NOM guidelines.

The length of observation should be based solely on clinical criteria. Patients with liver injuries may be safely discharged home in the presence of a normal abdominal examination and stable hemoglobin, regardless of the grade of injury. This guideline is safe and reduces LOS without increasing morbidity or mortality.