Adam Brooks (Nottingham / GB), Danielle Joyce (Nottingham / GB), Santiago Gouveia (Birmingham / GB), Marta Burak (Birmingham / GB), Angelo La Valle (Nottingham / GB), John-Joe Reilly (Nottingham / GB), Tom Diacon (Birmingham / GB), Lauren Blackburn (Nottingham / GB), Samuel Kitchen (Nottingham / GB), Iver Anders Gaski (Oslo / NO), Christine Gaarder (Oslo / NO), Pål Aksel Næss (Oslo / NO), David N Naumann (Nottingham / GB; Birmingham / GB)
Introduction
The liver is one of the most commonly injured organs in the body in cases of Major Trauma. Patients with severe liver injury carry a high risk of complications with significant mortality.
Patients and Methods
All patients who sustained severe liver trauma (AAST Grade IV and V) between 2012 and 2022 were identified using Trauma Audit and Research Network database for MTCs in Birmingham and Nottingham. Outcomes were compared between those managed by surgery vs non-operative management (NOM). Adjusted multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for surgical management as well as for survival and the development of liver-specific complications (adjusting for age, sex, ISS, AAST grade and polytrauma).
Results
There were 190 patients; median age was 28 years (IQR 20-41); 134 (71%) were male. The median ISS was 27 (IQR 17-41). Overall mortality was 7 % (14/190). A total of 122/190 (64%) patients were managed initially by NOM, with only 8/122 (7%) requiring subsequent surgery. Multivariable logistic regression models showed higher ISS, lower SBP on admission, Grade V injuries and penetrating trauma to be independent predictors for surgical treatment. There were 34/190 (18%) patients with liver-specific complications. There was no statistically significant difference between NOM and operative management groups for 30-day mortality (p=0.145), but patients in the NOM group had shorter ICU (p<0.001) and total hospital lengths of stay (p<0.001) compared to those in the operative group.
Conclusion
In this modern MTC setting, a high proportion of patients with severe liver trauma were managed by NOM with a low failure rate. Overall mortality rate was low, but liver-specific complications were common. These data support the evolution of traumatic liver injury management in the UK and favour NOM even in severe liver injuries.
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