Trauma patients with blunt abdominal solid organ injuries are at high risk for venous thromboembolism (VTE), but the optimal time to safely administer chemical thromboprophylaxis is controversial, especially for patients who are managed nonoperatively due to increased risk of hemorrhage. We sought to compare failure of nonoperative management (NOM) and VTE events based on timing of chemical thromboprophylaxis initiation.
A systematic review was conducted in PubMed and Embase databases. Studies were included if they evaluated timing of initiation of chemical thromboprophylaxis in trauma patients who underwent NOM of blunt solid organ injuries. Outcomes included failure of NOM and incidence of VTE. A random-effects meta-analysis was performed comparing patients who received late (>48 h) versus early thromboprophylaxis initiation.
Twelve retrospective cohort studies, comprising 21,909 patients, were included. Three studies, including 6375 patients, provided data on adjusted outcomes. Pooled adjusted analysis demonstrated no difference in failure of NOM in patients receiving late versus early thromboprophylaxis (odds ratio [OR] 0.92, 95% confidence interval [CI]:0.4-2.14). When including all unadjusted studies, even those at high risk of bias, there remained no difference in failure of NOM (OR 1.16, 95% CI:0.72-1.86). In the adjusted analysis for VTE events, which had 6259 patients between two studies, patients receiving late chemical thromboprophylaxis had a higher risk of VTE compared with those who received early thromboprophylaxis (OR 1.89, 95% CI:1.15-3.12).
Based on current observational evidence, initiation of prophylaxis before 48 h is associated with lower VTE rates without higher risk of failure of NOM.

BACKGROUND: There is considerable interest in the use of tranexamic acid (TXA) for the control of hemorrhages in trauma patients. Multiple recent studies found that TXA used in the setting of a suspected significant hemorrhage in trauma patients significantly reduced mortality. To date, there are no cited studies that specifically address hemorrhage due to solid organ injury (i.e., kidneys, liver, and spleen) and TXA use in humans. Our current research addresses whether TXA is effective in reducing complications and mortality from traumatic hemorrhage in the setting of a specific solid organ injury.
METHODS: We conducted a retrospective observational cohort study utilizing propensity score matching at Arrowhead Regional Medical Center (ARMC) from February 1, 2009 to February 1, 2019. This study period marks five years prior to and five years after February 1, 2004, which is the date when TXA first started to be used at ARMC in the management of traumatic hemorrhage. We compared for statistical difference between corresponding injury types in the TXA and non-TXA groups.
RESULTS: Before the propensity matching, there were 123 patients who received TXA and 118 patients who did not. After propensity match for age and injury severity score (ISS), 35 patients were included in each group. We found no statistically significant difference between TXA and non-TXA treatment groups in terms of mortality at 24 hours (p-value=0.4945), mortality at 48 hours (p-value=0.4945), and mortality at 28 days (p-value=0.7426). We found no statistically significant difference between the need for interventional radiology intervention at 72 hours (p-value=0.3932), surgical intervention at 72 hours (p-value=0.2123) and possible TXA related complications (p-value=1).
CONCLUSIONS: Although prior studies showed that TXA use in the setting of trauma may be beneficial, the specific candidate-selection criteria remain unclear. The results of our study suggest that the benefit from TXA in the setting of the isolated splenic, liver, and or renal injury may be negligible. We believe that this first-of-its-kind study adds to the growing body of knowledge about the utility of TXA and helps guide patient-selection criteria.

The management of pediatric liver trauma has evolved significantly over the last few decades. While surgical intervention was frequently and mostly unsuccessfully practiced during the first half of the last century, the 1960s were witness to the birth and gradual acceptance of non-operative management of these injuries. In 2000, the American Pediatric Surgical Association (APSA) Trauma Committee disseminated evidenced-based guidelines to help guide the non-operative management of pediatric blunt solid organ injury. The guidelines significantly contributed to conformity in the management of these patients. Since then, a number of well-designed studies have questioned the strict categorization of these injuries and have led to a renewed reliance on clinical signs of the patient\'s hemodynamic status. In 2019, APSA introduced an updated set of guidelines emphasizing the use of physiologic status rather than radiologic grade as a driver of clinical decision making for these injuries. This review will focus on liver injuries, in particular blunt injury, as this mechanism is by far the most commonly seen in children. Procedures required when non-operative management fails will be detailed, including surgery, angioembolization, and less commonly employed interventions. Finally, the updated inpatient and post-discharge aspects of care will be reviewed, including hemoglobin monitoring, bedrest, length of hospital stay, and activity restriction.

BACKGROUND: The objective was to analyze patterns of injury, management, imaging, and follow-up care of renal trauma at a Swiss level 1 trauma center.
METHODS: We examined 138 patients (>16 years) with renal organ injuries who presented to our institution between January 2008 and March 2018. Data on demographics, patterns of injury, clinical presentation, management, and follow-up were recorded.
RESULTS: The injury grade of the 142 injured kidneys was grade 1 in 25% (n = 36), grade 2 in 16% (n = 23), grade 3 in 32% (n = 46), grade 4 in 24% (n = 34), and grade 5 in 2% (n = 3). The predominant injury mechanism was winter sports (45%). Conservative management was successful in all grade 1 renal injuries, and 91%, 86%, 35%, and 33% of grade 2, 3, 4, and 5 injuries, respectively. Early follow-up with CT or MRI scan was performed in 23% of grade 1-3 injuries and 57% of grade 4-5 injuries with clinical signs of complications as the most frequent indication for grade 1-3 injuries and routine follow-up imaging for grade 4-5 injuries, respectively. In follow-up care (1-9 months after injury) imaging showed persistent pathologies in 39% of grade 1-3 renal injuries and 62% of grade 4-5 injuries.
CONCLUSIONS: Most minor renal injuries (grade 1-3) can be successfully managed conservatively. Early follow-up imaging is indicated for patients showing clinical signs of complications. Routine repeat imaging may not be justified for high-grade renal injuries without clinical symptoms. Re-imaging in follow-up care still lacks evidence-based recommendations.