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

INTRODUCTION: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.