Low-grade blunt hepatic injury and benefits of intensive care unit monitoring

Background: We investigated low-grade, hemodynamically normal BHI associated with any of three interventions indicating ICU observation. Methods: BHI between 01/01/96-6/30/14 were reviewed. Two groups included: Group A (BHI grades 1-3) with normal initial systolic BP and Group B (all other BHI). Interventions necessitating ICU observation were defined with three criteria: PRC transfusion within 24 h, angiography, or laparotomy. Between group and Group A subgroup outcomes were reported. Results: Group A (n = 1088) had lower ISS, LOS, PRCs transfused, and mortality (p < 0.01) than Group B (n = 636). For any of the criteria indicating ICU admission, Group A had a NPV, sensitivity and specificity of 67.9%, 30.3%, and 75.3% respectively; isolated BHI (n = 188) sensitivity, specificity and NPV were 17.8%, 88.1%, and 77.3%. Laparotomy specifically for BHI was 2.0% for Grade I/II, 4.3% for Grade III subgroups. Conclusions: Hemodynamic stability is insufficient as a sole criterion for safe admission of low-grade BHI to a non-ICU environment.