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Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effectiveness of routine repeat computed tomography (CT) for nonoperative management (NOM) of adults with blunt liver and/or spleen injury.

Methods

We conducted a systematic review of randomized and non-randomized controlled trials (RCTs), quasi-experimental and observational studies of repeat CT in adult patients with blunt abdominal injury. We searched Medline, Embase, Web of Science, and Cochrane Central from their inception to October 2020 using Cochrane guidelines. Primary outcomes were change in clinical management (e.g., emergency surgery, embolization, blood transfusion, clinical surveillance), mortality, and complications. Secondary outcomes were hospital readmission and length of stay.

Results

Search results yielded 1611 studies of which 28 studies including 2646 patients met our inclusion criteria. The majority reported on liver (n = 9) or spleen injury (n = 16) or both (n = 3). No RCTs were identified. Meta-analyses were not possible because no study performed direct comparisons of study outcomes across intervention groups. Only seven of the twenty-eight studies reported whether repeat CT was routine or prompted by clinical indication. In these 7 studies, among the 254 repeat CT performed, 188 (74%) were routine and 8 (4%) of these led to a change in clinical management. Of the 66 (26%) repeated CT prompted by clinical indication, 31 (47%) led to a change in management. We found no data allowing comparison of any other outcomes across intervention groups.

Conclusion

Routine repeat CT without clinical indication is not useful in the management of patients with liver and/or spleen injury. However, effect estimates were imprecise and included studies were of low methodological quality. Given the risks of unnecessary radiation and costs associated with repeat CT, future research should aim to estimate the frequency of such practices and assess practice variation.

Level of evidence

Systematic reviews and meta-analyses, Level II.

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Acknowledgements

We would like to thank Frederick Bergeron, librarian consultant at Université Laval, for his guidance in the conception of our search strategies.

Funding

This research is funded by the Canadian Institutes of Health Research (Foundation Grant, #353374) and the Fonds de Recherche du Québec—Santé (career award, LM; doctoral research award #260238, KMB).

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Authors and Affiliations

  1. Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada

    Khadidja Malloum Boukar, Lynne Moore & Kahina Soltana

  2. Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l’Enfant-Jésus), Université Laval, Z-201, 1401, 18e rue, Québec, QC, G1J 1Z4, Canada

    Khadidja Malloum Boukar, Lynne Moore, Pier-Alexandre Tardif & Kahina Soltana

  3. Department of Surgery, University of Calgary, Calgary, Canada

    Natalie Yanchar & John Kortbeek

  4. Department of Surgery, University of Health Sciences, Maryland, USA

    Howard Champion

  5. Department of Surgery, Laval University, Québec, QC, Canada

    Julien Clement

Authors
  1. Khadidja Malloum Boukar
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  2. Lynne Moore
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  4. Kahina Soltana
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  5. Natalie Yanchar
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  7. Howard Champion
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  8. Julien Clement
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Contributions

KMB carried out the study, developed the methodology, performed the analysis, and wrote the manuscript. LM contributed to the development of research objectives and inclusion criteria, contributed to the elaboration of keywords, validated the search strategy and the data extraction form, critically revised and approved the final version of the manuscript, and supervised the findings of this work. P-AT contributed to the elaboration of keywords, the search strategy and the data extraction form, and critically revised and approved the final version of the manuscript. KS contributed to the data extraction form, and critically revised and approved the final version of the manuscript. NY, HC, JK, and JC contributed to the development of the research protocol and search strategy, revised the manuscript, and approved the final version.

Corresponding author

Correspondence to Khadidja Malloum Boukar.

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Malloum Boukar, K., Moore, L., Tardif, PA. et al. Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review. Eur J Trauma Emerg Surg 47, 1753–1761 (2021). https://doi.org/10.1007/s00068-020-01584-x

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