Nonoperative Solid Organ Injury Screening for Delayed Presentation of Vascular Injury
Original Date: 07/2025 | Location: MH Katy
Problem: Rarely, nonoperatively treated solid organ injuries can develop delayed catastrophic bleeding complications. The following guideline was developed on expert consensus aiming to decrease the incidence of this problem.
Intervention:
Nonoperatively treated solid organ injuries (including those s/p angiography +/- embolization) should undergo repeat CT screening for development. Study of choice is a CT Abdomen/Pelvis Trauma protocol (Arterial, venous, and 5-minute delay) and includes nonoperatively treated solid organ (liver, kidney, spleen) injuries.
Patients to undergo routine repeat CT between 48 and 72 hours after time of injury, timed ideally at 5 am.
Those patients to include:
- Grades 4 and 5 solid organ injuries
- Grade 3 or higher solid organ injuries from a penetrating mechanism
- Other high-risk solid organ injuries at surgeon discretion
Additional comments:
- If patient is otherwise ready for discharge, CT scan to be obtained earlier to facilitate timely discharge
- Patients who are clinically unstable and obtaining repeat CT scan risks additional decompensation (high ventilator settings or difficult to control ICP issues) may have screening CT scan delayed until patient is stable
Interpretation of findings:
- Vascular injuries identified on screening CTs will be reviewed by surgeon and IR faculty regarding risk/benefit of embolization treatment for the lesion