High Success With Nonoperative Management of Blunt Hepatic Trauma

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Abstract
THE PREVALENCE of blunt liver injury has increased during the past 3 decades.1,2 It is unknown if this increase represents an absolute increase in the number of liver injuries or if it is an artificial effect due to better diagnosis through the liberal use of computed tomography (CT) and more advanced trauma registries. Furthermore, an absolute increase in the incidence of nonoperatively managed liver injuries is unequivocal.3,4 Multiple studies1-12 have shown that nonoperative management of liver injuries (NOMLI) is effective. However, most of these studies are retrospective. In addition, the criteria for NOMLI differ among centers and include different thresholds of age, hemodynamic compromise, abdominal tenderness, injury severity, associated extra-abdominal injuries, and grade of liver injury. Some researchers13 have reported a disturbing incidence of liver-related complications in patients undergoing NOMLI. Therefore, operative care is still frequently offered for liver injury. A multicenter study,14 representing many state-of-the-art US trauma centers, reported that fewer than half of patients with blunt liver injury are candidates for NOMLI.