• Rosemary A Kozar, Frederick A Moore, C Clay Cothren, Ernest E Moore, Matthew Sena, Eileen M Bulger, Charles C Miller, Brian Eastridge, Eric Acheson, Susan I Brundage, Monika Tataria, Mary McCarthy, and John B Holcomb.
• University of Texas, Houston 77030, USA. rosemary.a.kozar@uth.tmc.edu
• Arch Surg Chicago. 2006 May 1;141(5):451-8; discussion 458-9.

HypothesisEarly risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified.DesignMulticenter historical cohort.SettingSeven urban level I trauma centers.PatientsPatients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours.InterventionNonoperative treatment of complex blunt hepatic injuries.Main Outcome MeasuresComplications and treatment strategies.ResultsOf 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis.ConclusionsNonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.

32 keywords...

hide…