Surveillance imaging following liver trauma has a low detection rate of liver complications.

Abstract

Surveillance imaging following liver trauma (LT) in asymptomatic patients is performed in many centers. Recent guidelines recommend follow-up imaging if there is a clinical indication. To compare liver complications detected through surveillance versus selective imaging in patients following known LT. A retrospective review of a prospective trauma registry was undertaken including all patients that presented with LT at a single center. All radiology images and reports of patients with LT were reviewed. The indication for follow-up imaging was ascertained by reviewing the radiology request and the patients' clinical record. During the 14-year study, 450 patients were admitted with LT. Liver complications occurred in 50 patients (11%). Follow-up imaging was performed in 169 patients (38%). Of the patients having follow-up imaging, 92 patients had this for clinical deterioration, 55 had surveillance imaging and 22 had follow-up imaging for a non-liver indication. The majority of patients undergoing surveillance imaging had an AAST grade III-V injury (68%). None of the 55 patients having surveillance imaging had a liver complication. In contrast, 36 out of 92 patients having follow-up imaging for clinical deterioration had a complication within their liver (39%). There was a significantly higher incidence of complication detection for clinical deterioration versus surveillance imaging (p = < 0.0001). Although complications following high-grade LT are common, they invariably cause clinical deterioration. There is no evidence for surveillance imaging following LT. Follow-up imaging should be guided by the patient's clinical condition.