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Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 271-277

Non-operative management of blunt hepatic injury: Early return to function, chemical prophylaxis, and elucidation of Grade III injuries

1 Indiana University, Indianapolis, Trauma and Critical Care, Indiana, USA
2 Grant Medical Center, Trauma and Acute Care Surgery, Columbus; Ohio University Heritage College of Osteopathic Medicine, Ohio, USA
3 Grant Medical Center, Trauma and Acute Care Surgery, Columbus, Ohio, USA

Correspondence Address:
Dr. M Chance Spalding
Grant Medical Center, OhioHealth, 111 South Grant Avenue, Columbus, Ohio 43215-1898; Ohio University Heritage College of Osteopathic Medicine, Ohio
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_93_17

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Background: Selective non-operative management of blunt hepatic trauma has shown decreased mortality and iatrogenic injury. Evidence-based recommendations are difficult to obtain regarding management of Grade III hepatic injuries and safe timing to implement return to function measures (enteral intake, chemical deep vein thrombosis [DVT] prophylaxis, and ambulation). Materials and Methods: This is a prospective, observational study of 130 trauma patients with blunt hepatic injuries over 2 years. A guideline was utilized to emphasize early hepatobiliary iminodiacetic acid scan and return to function measures at 24 h after injury. Patients were treated non-operatively with endoscopic retrograde cholangiopancreatography, percutaneous drainage, or embolization per evidence-based guidelines. Results: Fifty-seven patients suffered Grade III–V blunt liver injury. The biliary leak rate was higher for Grade IV and V liver injuries than Grade III (48%, 43%, and 12%, respectively) compared to lower grade injuries (0%). There was no significant difference in complications from initiation of chemical DVT prophylaxis, ambulation, or early enteral intake as a function of grade of hepatic injury. The average time to progression of treatment was 24 h and independent of the grade of liver injury. High-grade liver injuries were associated with lower age, increased injury severity score, and increased Intensive Care Unit length of stay. Conclusions: Trauma providers should consider Grade III liver injuries as low-grade injuries and treat accordingly. However, Grade IV and V injuries fail non-operative management more often than other grade injuries. Early enteral nutrition, chemical DVT prophylaxis, and ambulation are safe regardless of the grade of hepatic injury. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice.

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