Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 28, 2016; 8(15): 644-648
Published online May 28, 2016. doi: 10.4254/wjh.v8.i15.644
Outcome analysis of management of liver trauma: A 10-year experience at a trauma center
Wong Hoi She, Tan To Cheung, Wing Chiu Dai, Simon H Y Tsang, Albert C Y Chan, Daniel K H Tong, Gilberto K K Leung, Chung Mau Lo
Wong Hoi She, Tan To Cheung, Wing Chiu Dai, Simon H Y Tsang, Albert C Y Chan, Daniel K H Tong, Gilberto K K Leung, Chung Mau Lo, Department of Surgery, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
Author contributions: She WH was responsible for study design, literature search, collection, analysis and interpretation of data, and manuscript drafting; Cheung TT was responsible for study design, analysis and interpretation of data, and writing and critical revision of manuscript; Dai WC, Tsang SHY and Chan ACY were responsible for study design and critical revision of manuscript; Tong DKH, Leung GKK and Lo CM were responsible for study design; Cheung TT is the guarantor.
Institutional review board statement: Review and approval of this particular study by the Institutional Review Board of The University of Hong Kong are not necessary since the Board permits all use of patient data in retrospective studies provided that no individual patients can be identified.
Informed consent statement: Consent by patients was not required for this particular study since this is an overall review of patient data with no individual patients being identified.
Conflict-of-interest statement: None of the authors has any conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tan To Cheung, Associate Professor, Department of Surgery, Queen Mary Hospital, the University of Hong Kong, No. 102 Pok Fu Lam Road, Hong Kong, China. tantocheung@hotmail.com
Telephone: +852-22553025 Fax: +852-28165284
Received: January 21, 2016
Peer-review started: January 22, 2016
First decision: February 22, 2016
Revised: March 11, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: May 28, 2016
Abstract

AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.

METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.

RESULTS: Seven (30.4%) patients in group 1 and 10 (28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8% (48/58) of the patients and penetrative trauma in 17.2% (10/58). A higher injury severity score (ISS) was observed in group 2 (median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable (65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival (91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality (P = 0.004, hazard ratio = 1.035, 95%CI: 1.011-1.060).

CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

Keywords: Non-operative management, Liver trauma, Multiple injuries, Penetrative trauma, Liver laceration, Blunt trauma

Core tip: Liver trauma patients who have not only liver injury but also associated injury outside the liver usually have a high injury severity score (ISS) and a bigger chance of morbidity and death. Management of liver trauma features surgical and nonsurgical approaches. Choice of approach should depend on individual patients’ overall clinical condition rather than just ISS or imaging findings. The applicability of nonsurgical approach has extended to penetrative injuries with success.