Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial

Lindsey L. Perea; Kelsey L. Fletcher; Madison E. Morgan; Allison G. McNickle; Douglas Fraser; Martin Rosenthal; Ethan Wang; Anna Goldenberg; Emily Hancin; Alison A. Smith; Jack A. Leoni; Jonathan P. Meizoso; Christopher F. O’Neil; Matthew Noorbakhsh; Khalid Almahmoud; David Lapham; Erica Sais; Daniel Cullinane; Carolyne Falank; Adrian A. Maung; Bishwajit Bhattacharya; Paul Bjordahl; Jenny Guido; Alexandra Dixon; Amanda Carlson; Pascal Udekwu; Chloe Shell; Jaroslaw W. Bilaniuk; Zoltan H. Nemeth; Christopher A. Butts; Julia Zorn; Mentor Ahmeti; Steven Briggs; James M. Haan; Kelly Lightwine; John Oh; Gary Marshall; Morgan Collom; Richard Lewis; Greggory Davis; Asanthi Ratnasekera; Oluwadara Okorafor; Meaghan Broderick; Rishi Kundi; Thomas Muse; Charmi Mehta; Michael Collins; Jeffrey Lawrence; Lewis A. Jacobson; Jamie Williams; Kaily Ewing; Joel Narveson; Mark Lieser; Jill Streams; Stephen Gadomski; John D. Berne; Dalier Rodriguez Mederos; Amanda L. Teichman; Rachel L. Choron; Jennifer Grant; Nicole Frederick; David Evans; Stephanie Doris; Dane Scantling; Aksel Laudon; Patrick Craft; Jordan Kirsch; William Brigode; Johanna S. Stecher; Jeffry Nahmias; Claudia Alvarez; Vasileios Mousafeiris; Francesk Mulita; Morgan Turcotte; Tyler Holliday; Christopher P. Michetti; Nina Glass; Alexandra Jackovich; Brittany Bankhead; Brevin Thompson; Sharfuddin Chowdhury; Brian Thurston; Carolyn Bailey; Kellie Bresz; Michael Horst; Andrew Bernard; Joshua P. Hazelton

doi:10.1097/SLA.0000000000006831

Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial

Lindsey L. Perea^*, Kelsey L. Fletcher, Madison E. Morgan, Allison G. McNickle, Douglas Fraser, Martin Rosenthal, Ethan Wang, Anna Goldenberg, Emily Hancin, Alison A. Smith, Jack A. Leoni, Jonathan P. Meizoso, Christopher F. O’Neil, Matthew Noorbakhsh, Khalid Almahmoud, David Lapham, Erica Sais, Daniel Cullinane, Carolyne Falank, Adrian A. MaungBishwajit Bhattacharya, Paul Bjordahl, Jenny Guido, Alexandra Dixon, Amanda Carlson, Pascal Udekwu, Chloe Shell, Jaroslaw W. Bilaniuk, Zoltan H. Nemeth, Christopher A. Butts, Julia Zorn, Mentor Ahmeti, Steven Briggs, James M. Haan, Kelly Lightwine, John Oh, Gary Marshall, Morgan Collom, Richard Lewis, Greggory Davis, Asanthi Ratnasekera, Oluwadara Okorafor, Meaghan Broderick, Rishi Kundi, Thomas Muse, Charmi Mehta, Michael Collins, Jeffrey Lawrence, Lewis A. Jacobson, Jamie Williams, Kaily Ewing, Joel Narveson, Mark Lieser, Jill Streams, Stephen Gadomski, John D. Berne, Dalier Rodriguez Mederos, Amanda L. Teichman, Rachel L. Choron, Jennifer Grant, Nicole Frederick, David Evans, Stephanie Doris, Dane Scantling, Aksel Laudon, Patrick Craft, Jordan Kirsch, William Brigode, Johanna S. Stecher, Jeffry Nahmias, Claudia Alvarez, Vasileios Mousafeiris, Francesk Mulita, Morgan Turcotte, Tyler Holliday, Christopher P. Michetti, Nina Glass, Alexandra Jackovich, Brittany Bankhead, Brevin Thompson, Sharfuddin Chowdhury, Brian Thurston, Carolyn Bailey, Kellie Bresz, Michael Horst, Andrew Bernard, Joshua P. Hazelton

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications. Background: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate- to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition. Methods: We performed a 4-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention. Results: We identified 2341 BLI and 2143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822 (35.1%) BLI patients [SI: 457 (55.5%), CC: 365 (44.5%)] and 758 (27.9%) BSI patients [SI: 478 (63.1%), CC: 280 (37.0%)]. Complications were identified on repeat imaging in BLI: 167 (7.1%) [SI: 72 (43.1%), CC: 95 (56.9%)] and BSI: 203 (7.5%) [SI: 91 (44.8%), CC: 112 (55.2%)]. Of patients with BLI complications, 96 (57.8%) [SI: 37 (38.5%), CC: 59 (61.5%)] underwent an intervention. Of patients with BSI complications, 133 (65.5%) [SI: 56 (42.1%), CC: 77 (57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48 to 72 hours. Conclusions: Scheduled repeat imaging for asymptomatic patients with BLI grade 4 to 5 and BSI grade 3 to 5 within 48 to 72 hours from time of diagnosis allows for identification of complications before a change in the patient’s clinical condition.

Original language	English
Pages (from-to)	580-591
Number of pages	12
Journal	Annals of surgery
Volume	282
Issue number	4
DOIs	https://doi.org/10.1097/SLA.0000000000006831
State	Published - 1 Oct 2025

Keywords

(Ann Surg 2025;282:580–591)
blunt liver injury
blunt spleen injury
delayed complications
nonoperative management
repeat imaging

Access to Document

10.1097/SLA.0000000000006831

Cite this

Perea, L. L., Fletcher, K. L., Morgan, M. E., McNickle, A. G., Fraser, D., Rosenthal, M., Wang, E., Goldenberg, A., Hancin, E., Smith, A. A., Leoni, J. A., Meizoso, J. P., O’Neil, C. F., Noorbakhsh, M., Almahmoud, K., Lapham, D., Sais, E., Cullinane, D., Falank, C., ... Hazelton, J. P. (2025). Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial. Annals of surgery, 282(4), 580-591. https://doi.org/10.1097/SLA.0000000000006831

@article{f3cb73e2954e412f93baf10e7439d7fd,

title = "Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial",

abstract = "Objective: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications. Background: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate- to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition. Methods: We performed a 4-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention. Results: We identified 2341 BLI and 2143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822 (35.1%) BLI patients [SI: 457 (55.5%), CC: 365 (44.5%)] and 758 (27.9%) BSI patients [SI: 478 (63.1%), CC: 280 (37.0%)]. Complications were identified on repeat imaging in BLI: 167 (7.1%) [SI: 72 (43.1%), CC: 95 (56.9%)] and BSI: 203 (7.5%) [SI: 91 (44.8%), CC: 112 (55.2%)]. Of patients with BLI complications, 96 (57.8%) [SI: 37 (38.5%), CC: 59 (61.5%)] underwent an intervention. Of patients with BSI complications, 133 (65.5%) [SI: 56 (42.1%), CC: 77 (57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48 to 72 hours. Conclusions: Scheduled repeat imaging for asymptomatic patients with BLI grade 4 to 5 and BSI grade 3 to 5 within 48 to 72 hours from time of diagnosis allows for identification of complications before a change in the patient{\textquoteright}s clinical condition.",

keywords = "(Ann Surg 2025;282:580–591), blunt liver injury, blunt spleen injury, delayed complications, nonoperative management, repeat imaging",

author = "Perea, {Lindsey L.} and Fletcher, {Kelsey L.} and Morgan, {Madison E.} and McNickle, {Allison G.} and Douglas Fraser and Martin Rosenthal and Ethan Wang and Anna Goldenberg and Emily Hancin and Smith, {Alison A.} and Leoni, {Jack A.} and Meizoso, {Jonathan P.} and O{\textquoteright}Neil, {Christopher F.} and Matthew Noorbakhsh and Khalid Almahmoud and David Lapham and Erica Sais and Daniel Cullinane and Carolyne Falank and Maung, {Adrian A.} and Bishwajit Bhattacharya and Paul Bjordahl and Jenny Guido and Alexandra Dixon and Amanda Carlson and Pascal Udekwu and Chloe Shell and Bilaniuk, {Jaroslaw W.} and Nemeth, {Zoltan H.} and Butts, {Christopher A.} and Julia Zorn and Mentor Ahmeti and Steven Briggs and Haan, {James M.} and Kelly Lightwine and John Oh and Gary Marshall and Morgan Collom and Richard Lewis and Greggory Davis and Asanthi Ratnasekera and Oluwadara Okorafor and Meaghan Broderick and Rishi Kundi and Thomas Muse and Charmi Mehta and Michael Collins and Jeffrey Lawrence and Jacobson, {Lewis A.} and Jamie Williams and Kaily Ewing and Joel Narveson and Mark Lieser and Jill Streams and Stephen Gadomski and Berne, {John D.} and Mederos, {Dalier Rodriguez} and Teichman, {Amanda L.} and Choron, {Rachel L.} and Jennifer Grant and Nicole Frederick and David Evans and Stephanie Doris and Dane Scantling and Aksel Laudon and Patrick Craft and Jordan Kirsch and William Brigode and Stecher, {Johanna S.} and Jeffry Nahmias and Claudia Alvarez and Vasileios Mousafeiris and Francesk Mulita and Morgan Turcotte and Tyler Holliday and Michetti, {Christopher P.} and Nina Glass and Alexandra Jackovich and Brittany Bankhead and Brevin Thompson and Sharfuddin Chowdhury and Brian Thurston and Carolyn Bailey and Kellie Bresz and Michael Horst and Andrew Bernard and Hazelton, {Joshua P.}",

year = "2025",

month = oct,

day = "1",

doi = "10.1097/SLA.0000000000006831",

language = "English",

volume = "282",

pages = "580--591",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

number = "4",

}

Perea, LL, Fletcher, KL, Morgan, ME, McNickle, AG, Fraser, D, Rosenthal, M, Wang, E, Goldenberg, A, Hancin, E, Smith, AA, Leoni, JA, Meizoso, JP, O’Neil, CF, Noorbakhsh, M, Almahmoud, K, Lapham, D, Sais, E, Cullinane, D, Falank, C, Maung, AA, Bhattacharya, B, Bjordahl, P, Guido, J, Dixon, A, Carlson, A, Udekwu, P, Shell, C, Bilaniuk, JW, Nemeth, ZH, Butts, CA, Zorn, J, Ahmeti, M, Briggs, S, Haan, JM, Lightwine, K, Oh, J, Marshall, G, Collom, M, Lewis, R, Davis, G, Ratnasekera, A, Okorafor, O, Broderick, M, Kundi, R, Muse, T, Mehta, C, Collins, M, Lawrence, J, Jacobson, LA, Williams, J, Ewing, K, Narveson, J, Lieser, M, Streams, J, Gadomski, S, Berne, JD, Mederos, DR, Teichman, AL, Choron, RL, Grant, J, Frederick, N, Evans, D, Doris, S, Scantling, D, Laudon, A, Craft, P, Kirsch, J, Brigode, W, Stecher, JS, Nahmias, J, Alvarez, C, Mousafeiris, V, Mulita, F, Turcotte, M, Holliday, T, Michetti, CP, Glass, N, Jackovich, A, Bankhead, B, Thompson, B, Chowdhury, S, Thurston, B, Bailey, C, Bresz, K, Horst, M, Bernard, A & Hazelton, JP 2025, 'Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial', Annals of surgery, vol. 282, no. 4, pp. 580-591. https://doi.org/10.1097/SLA.0000000000006831

Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial. / Perea, Lindsey L.; Fletcher, Kelsey L.; Morgan, Madison E. et al.
In: Annals of surgery, Vol. 282, No. 4, 01.10.2025, p. 580-591.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial

AU - Perea, Lindsey L.

AU - Fletcher, Kelsey L.

AU - Morgan, Madison E.

AU - McNickle, Allison G.

AU - Fraser, Douglas

AU - Rosenthal, Martin

AU - Wang, Ethan

AU - Goldenberg, Anna

AU - Hancin, Emily

AU - Smith, Alison A.

AU - Leoni, Jack A.

AU - Meizoso, Jonathan P.

AU - O’Neil, Christopher F.

AU - Noorbakhsh, Matthew

AU - Almahmoud, Khalid

AU - Lapham, David

AU - Sais, Erica

AU - Cullinane, Daniel

AU - Falank, Carolyne

AU - Maung, Adrian A.

AU - Bhattacharya, Bishwajit

AU - Bjordahl, Paul

AU - Guido, Jenny

AU - Dixon, Alexandra

AU - Carlson, Amanda

AU - Udekwu, Pascal

AU - Shell, Chloe

AU - Bilaniuk, Jaroslaw W.

AU - Nemeth, Zoltan H.

AU - Butts, Christopher A.

AU - Zorn, Julia

AU - Ahmeti, Mentor

AU - Briggs, Steven

AU - Haan, James M.

AU - Lightwine, Kelly

AU - Oh, John

AU - Marshall, Gary

AU - Collom, Morgan

AU - Lewis, Richard

AU - Davis, Greggory

AU - Ratnasekera, Asanthi

AU - Okorafor, Oluwadara

AU - Broderick, Meaghan

AU - Kundi, Rishi

AU - Muse, Thomas

AU - Mehta, Charmi

AU - Collins, Michael

AU - Lawrence, Jeffrey

AU - Jacobson, Lewis A.

AU - Williams, Jamie

AU - Ewing, Kaily

AU - Narveson, Joel

AU - Lieser, Mark

AU - Streams, Jill

AU - Gadomski, Stephen

AU - Berne, John D.

AU - Mederos, Dalier Rodriguez

AU - Teichman, Amanda L.

AU - Choron, Rachel L.

AU - Grant, Jennifer

AU - Frederick, Nicole

AU - Evans, David

AU - Doris, Stephanie

AU - Scantling, Dane

AU - Laudon, Aksel

AU - Craft, Patrick

AU - Kirsch, Jordan

AU - Brigode, William

AU - Stecher, Johanna S.

AU - Nahmias, Jeffry

AU - Alvarez, Claudia

AU - Mousafeiris, Vasileios

AU - Mulita, Francesk

AU - Turcotte, Morgan

AU - Holliday, Tyler

AU - Michetti, Christopher P.

AU - Glass, Nina

AU - Jackovich, Alexandra

AU - Bankhead, Brittany

AU - Thompson, Brevin

AU - Chowdhury, Sharfuddin

AU - Thurston, Brian

AU - Bailey, Carolyn

AU - Bresz, Kellie

AU - Horst, Michael

AU - Bernard, Andrew

AU - Hazelton, Joshua P.

PY - 2025/10/1

Y1 - 2025/10/1

N2 - Objective: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications. Background: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate- to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition. Methods: We performed a 4-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention. Results: We identified 2341 BLI and 2143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822 (35.1%) BLI patients [SI: 457 (55.5%), CC: 365 (44.5%)] and 758 (27.9%) BSI patients [SI: 478 (63.1%), CC: 280 (37.0%)]. Complications were identified on repeat imaging in BLI: 167 (7.1%) [SI: 72 (43.1%), CC: 95 (56.9%)] and BSI: 203 (7.5%) [SI: 91 (44.8%), CC: 112 (55.2%)]. Of patients with BLI complications, 96 (57.8%) [SI: 37 (38.5%), CC: 59 (61.5%)] underwent an intervention. Of patients with BSI complications, 133 (65.5%) [SI: 56 (42.1%), CC: 77 (57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48 to 72 hours. Conclusions: Scheduled repeat imaging for asymptomatic patients with BLI grade 4 to 5 and BSI grade 3 to 5 within 48 to 72 hours from time of diagnosis allows for identification of complications before a change in the patient’s clinical condition.

AB - Objective: The aim of this study was to assess whether blunt liver (BLI) and blunt spleen (BSI) injury patients benefit from repeat imaging to identify injury-related complications. Background: No consensus guidelines exist regarding the necessity of, or optimal timing for, repeat imaging in BLI and BSI patients undergoing nonoperative management (NOM). We hypothesize that scheduled repeat imaging of patients undergoing NOM for moderate- to high-grade BLI and BSI would result in identification of complications earlier than if repeat imaging is performed in response to a change in clinical condition. Methods: We performed a 4-year, 43-center, multinational, prospective observational study of adult patients undergoing initial NOM of BLI and/or BSI. Patients were grouped by reason for repeat imaging: scheduled imaging (SI) or imaging performed for clinical change (CC), and by whether findings on repeat imaging resulted in procedural or operative intervention. Results: We identified 2341 BLI and 2143 BSI patients (528 concomitant BLI/BSI). Repeat imaging was performed in 822 (35.1%) BLI patients [SI: 457 (55.5%), CC: 365 (44.5%)] and 758 (27.9%) BSI patients [SI: 478 (63.1%), CC: 280 (37.0%)]. Complications were identified on repeat imaging in BLI: 167 (7.1%) [SI: 72 (43.1%), CC: 95 (56.9%)] and BSI: 203 (7.5%) [SI: 91 (44.8%), CC: 112 (55.2%)]. Of patients with BLI complications, 96 (57.8%) [SI: 37 (38.5%), CC: 59 (61.5%)] underwent an intervention. Of patients with BSI complications, 133 (65.5%) [SI: 56 (42.1%), CC: 77 (57.9%)] underwent an intervention. Our data demonstrate that in BLI and BSI, most complications were identified within 48 to 72 hours. Conclusions: Scheduled repeat imaging for asymptomatic patients with BLI grade 4 to 5 and BSI grade 3 to 5 within 48 to 72 hours from time of diagnosis allows for identification of complications before a change in the patient’s clinical condition.

KW - (Ann Surg 2025;282:580–591)

KW - blunt liver injury

KW - blunt spleen injury

KW - delayed complications

KW - nonoperative management

KW - repeat imaging

UR - http://www.scopus.com/inward/record.url?scp=105010705745&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000006831

DO - 10.1097/SLA.0000000000006831

M3 - Article

AN - SCOPUS:105010705745

SN - 0003-4932

VL - 282

SP - 580

EP - 591

JO - Annals of surgery

JF - Annals of surgery

IS - 4

ER -

Perea LL, Fletcher KL, Morgan ME, McNickle AG, Fraser D, Rosenthal M et al. Moderate- to High-grade Blunt Liver and Spleen Injuries Warrant Repeat Imaging to Identify Treatable Complications Results of the Radiographic Evaluation of Delayed Solid Organ Complications EAST Multicenter Trial. Annals of surgery. 2025 Oct 1;282(4):580-591. doi: 10.1097/SLA.0000000000006831