Liver trauma is a relatively rare surgical emergency, but mortality and morbidity rates remain significant.
Furthermore, it is likely that surgeons outside specialist centers will have limited experience in its management
Therefore, best practice should be identified and a specialist approach developed.
In this study, the research team collected data from 52 consecutive patients over a 10-year period.
|Liver injury was a component of multiple trauma in 69% of patients.|
|British Journal of Surgery|
These data were examined in order to identify best practice in the management of these injuries.
The team found that the majority of injuries occurred as a result of road traffic accidents; 75% of the 52 patients were stable at presentation to the referring hospital.
In 69% of patients the liver injury was a component of multiple trauma.
Ultrasonography, computed tomography or no radiological investigation was used in the referring hospital in 35%, 48% and 17% patients, respectively.
In addition, operative management was undertaken in the referring hospital in 50% of patients.
The researchers found that the overall mortality rate was 23%, and increased with increasing grade of severity.
They determined that 8 of 26 patients managed surgically at the referring hospital died, compared with 4 of the 26 patients managed without operation. This difference was not statistically significant.
Furthermore, the median time from arrival at the referring hospital to operation was 4 hours for haemodynamically stable patients and 3 hours for those who were not.
Dr Brammer’s team concluded, “Most patients with liver trauma can be managed conservatively”.
“Operative management carried out in non-specialized units is associated with high mortality and morbidity rates”.
“Abdominal injuries should raise a high index of suspicion of liver injury, and the data suggest that computed tomography of the abdomen should precede laparotomy...to facilitate discussion with a specialist unit at the earliest opportunity”.