Reimaging High-Grade Blunt Hepatic Injuries: Revisiting the Role of Routine Surveillance in Modern Nonoperative...

Traumatic liver injuries are associated with significant morbidity and mortality. The value of routine postinjury imaging surveillance is uncertain, as is whether this value increases with higher grade injuries.

A multicenter retrospective review was performed at two level I trauma centers from 2015 to 2020. Adults with American Association for the Surgery of Trauma grades II-V liver lacerations following blunt trauma were included. Reimaging patterns, need for reintervention, and 30-d outcomes of grades II/III injuries ("lower grade liver injuries," LGLI) were compared to grades IV/V ("higher grade liver injuries," HGLI).

A total of 229 patients were included, 69.9% with LGLI and 30.1% with HGLI. Overall mortality was 15.3%. HGLI were more likely to be reimaged (69.2% versus 32.7%, P < 0.001). Comparing lower grade to higher grade injuries, there was no difference in time to reimaging (4 versus 4 d, P = 0.523). Patients with HGLI had more liver-specific complications (23.1% versus 2.0%, P < 0.001) and required more reinterventions (19.2% versus 2.6%, P < 0.001). Length of stay was longer (median 6 (interquartile range 4-13) versus median 10 (interquartile range 5-21), P = 0.044), and 30-d mortality was higher (27.5% versus 10.0%, P < 0.001) for HGLI. In multivariate analysis controlling for extrahepatic injuries, HGLI (odds ratio 3.10, 95% confidence interval 1.38-6.94, P = 0.006) and initial operative or Interventional Radiology management (odds ratio, 4.66; 95% confidence interval, 2.18-9.99, P < 0.001) were independently associated with reimaging.

A majority of patients with higher grade liver injuries undergo repeat imaging in the first several days postinjury and 19% require reintervention. Given the high rate of reintervention, routine imaging surveillance should be considered.