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International Journal of Emergency Medicine

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Open Access 01-12-2011 | Review

Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

Authors: Cornelis H van der Vlies, Dominique C Olthof, Menno Gaakeer, Kees J Ponsen, Otto M van Delden, J Carel Goslings

Published in: International Journal of Emergency Medicine | Issue 1/2011

Abstract

Background

In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization.

Aim

The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney.

Results

The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the literature is whether a whole body MDCT survey should be implemented in the primary survey.

Conclusions

The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the success rate to 95%. However, to date many controversies exist about the optimum patient selection for NOM, the proper role of angioembolization in NOM, the best technique and material to use in angioembolization, and the right follow-up strategy of patients sustaining blunt abdominal injury. Conducting a well-designed prospective clinical trial or a Delphi study would be preferable.

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Title: Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs
Authors: Cornelis H van der Vlies
Dominique C Olthof
Menno Gaakeer
Kees J Ponsen
Otto M van Delden
J Carel Goslings
Publication date: 01-12-2011
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 1/2011
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/1865-1380-4-47

At a glance: The STEP trials

Springer Medicine

Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

Abstract

Background

Aim

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aim

Results

Conclusions

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