BACKGROUND: Nonoperative management (NOM) has become the standard treatment in hemodynamically stable @entity1 with blunt @entity99 . While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult @entity1 with blunt @entity99 . METHODS: Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt @entity99 were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials. RESULTS: We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 @entity1 , were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p < 0.05), fluid resuscitation (p = 0.02), blood transfusion (p = 0.003), peritoneal signs (p < 0.0001), Injury Severity Score (ISS) (p = 0.03), and associated intra-abdominal injuries (p < 0.01). CONCLUSION: There is evidence that @entity1 presenting with clinical signs of shock, a high ISS, associated intra-abdominal injuries, and peritoneal signs are at an increased risk of failure of NOM for the treatment of blunt @entity99 . LEVEL OF EVIDENCE: Systematic review, level III.

Nonoperative management of blunt XXXX : A systematic review.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity99 :: ('MESH:D056486', 'Disease') :: ['hepatic injuries', 'liver injuries', 'hepatic trauma']
@entity99 :: (MESH:D056486,Disease) :: ['hepatic trauma']
