Accepted Manuscript Isolated Free Fluid on Abdominal CT in Blunt Trauma: Watch and Wait or Operate? Laura N. Gonser-Hafertepen , DO James W. Davis , MD FACS John F. Bilello , MD FACS Shana L. Ballow , DO Lawrence P. Sue , MD FACS Kathleen M. Cagle , FNP-C Chandrasekar Venugopal , MD DABR Stephen C. Hafertepen , MD Krista L. Kaups , MD FACS PII:
S1072-7515(14)00443-8
DOI:
10.1016/j.jamcollsurg.2014.04.020
Reference:
ACS 7430
To appear in:
Journal of the American College of Surgeons
Received Date: 4 March 2014 Revised Date:
8 April 2014
Accepted Date: 15 April 2014
Please cite this article as: Gonser-Hafertepen LN, Davis JW, Bilello JF, Ballow SL, Sue LP, Cagle KM, Venugopal C, Hafertepen SC, Kaups KL, Isolated Free Fluid on Abdominal CT in Blunt Trauma: Watch and Wait or Operate?, Journal of the American College of Surgeons (2014), doi: 10.1016/ j.jamcollsurg.2014.04.020. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Isolated Free Fluid on Abdominal CT in Blunt Trauma: Watch and Wait or Operate?
Laura N Gonser-Hafertepen, DO, James W Davis, MD FACS, John F Bilello, MD FACS, Shana
RI PT
L Ballow, DO, Lawrence P Sue, MD FACS, Kathleen M Cagle, FNP-C, Chandrasekar Venugopal, MD DABR, Stephen C Hafertepen, MD, Krista L Kaups, MD FACS
M AN U
Disclosure Information: Nothing to disclose.
SC
UCSF Fresno / Community Regional Medical Center, Fresno, CA
Presented at the Western Trauma Association 43rd Annual Meeting, Snowmass, CO, March 2013 Running head: Isolated Free Fluid on CT in Blunt Trauma
AC C
EP
TE D
Correspondence address: Laura Gonser-Hafertepen, DO - Community Regional Medical Center, Department of Surgery, 1st Floor, 2823 Fresno Street, Fresno, CA 93721.
Page 1 of 24
ACCEPTED MANUSCRIPT
ABSTRACT Background: Isolated free fluid (FF) on abdominal computed tomography (CT) in stable blunt trauma patients may indicate the presence of hollow viscus injury. No criteria exist to
RI PT
differentiate treatment by operative exploration versus observation. The goals of this study were to determine the incidence of isolated FF and to identify factors that discriminate between patients who should undergo operative exploration versus observation.
SC
Study Design: A review of blunt trauma patients at a Level I Trauma Center from 7/2009-3/2012 was performed. Patients with a CT showing isolated FF after blunt trauma were included. Data
M AN U
collected included demographics, injury severity, physical examination, CT, and operative findings.
Results: 2,899 patients had CT scans of which 156 patients (5.4%) had isolated FF. The therapeutic operative (TO) group had 13 patients; 9 had immediate operation and 4 failed non-
TE D
operative management. The non-operative/non-therapeutic operation group (NO/NT) consisted of 142 patients with successful non-operative management and 1 patient with a non-therapeutic operation. Abdominal tenderness was documented in 69% of TO group and 23% of NO/NT
EP
group (OR 7.5, p
S1072-7515(14)00443-8
DOI:
10.1016/j.jamcollsurg.2014.04.020
Reference:
ACS 7430
To appear in:
Journal of the American College of Surgeons
Received Date: 4 March 2014 Revised Date:
8 April 2014
Accepted Date: 15 April 2014
Please cite this article as: Gonser-Hafertepen LN, Davis JW, Bilello JF, Ballow SL, Sue LP, Cagle KM, Venugopal C, Hafertepen SC, Kaups KL, Isolated Free Fluid on Abdominal CT in Blunt Trauma: Watch and Wait or Operate?, Journal of the American College of Surgeons (2014), doi: 10.1016/ j.jamcollsurg.2014.04.020. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Isolated Free Fluid on Abdominal CT in Blunt Trauma: Watch and Wait or Operate?
Laura N Gonser-Hafertepen, DO, James W Davis, MD FACS, John F Bilello, MD FACS, Shana
RI PT
L Ballow, DO, Lawrence P Sue, MD FACS, Kathleen M Cagle, FNP-C, Chandrasekar Venugopal, MD DABR, Stephen C Hafertepen, MD, Krista L Kaups, MD FACS
M AN U
Disclosure Information: Nothing to disclose.
SC
UCSF Fresno / Community Regional Medical Center, Fresno, CA
Presented at the Western Trauma Association 43rd Annual Meeting, Snowmass, CO, March 2013 Running head: Isolated Free Fluid on CT in Blunt Trauma
AC C
EP
TE D
Correspondence address: Laura Gonser-Hafertepen, DO - Community Regional Medical Center, Department of Surgery, 1st Floor, 2823 Fresno Street, Fresno, CA 93721.
Page 1 of 24
ACCEPTED MANUSCRIPT
ABSTRACT Background: Isolated free fluid (FF) on abdominal computed tomography (CT) in stable blunt trauma patients may indicate the presence of hollow viscus injury. No criteria exist to
RI PT
differentiate treatment by operative exploration versus observation. The goals of this study were to determine the incidence of isolated FF and to identify factors that discriminate between patients who should undergo operative exploration versus observation.
SC
Study Design: A review of blunt trauma patients at a Level I Trauma Center from 7/2009-3/2012 was performed. Patients with a CT showing isolated FF after blunt trauma were included. Data
M AN U
collected included demographics, injury severity, physical examination, CT, and operative findings.
Results: 2,899 patients had CT scans of which 156 patients (5.4%) had isolated FF. The therapeutic operative (TO) group had 13 patients; 9 had immediate operation and 4 failed non-
TE D
operative management. The non-operative/non-therapeutic operation group (NO/NT) consisted of 142 patients with successful non-operative management and 1 patient with a non-therapeutic operation. Abdominal tenderness was documented in 69% of TO group and 23% of NO/NT
EP
group (OR 7.5, p
