Central Surgical AssociationSelective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy
Section snippets
Patients and methods
After approval by the institutional review board, all trauma patients who sustained a blunt hepatic injury from 1993 to 2003 were identified by the trauma registry at the University of Louisville Hospital. Records then were reviewed for demographics, severity of injury, severity of liver injury, associated concomitant injuries, management scheme, adjunctive procedures, and outcome data. The grade of liver injury was determined from initial CT determination or intraoperative findings based on
Results
A total of 561 patients who incurred a hepatic injury from blunt trauma were identified from 1993 to 2003. Fifty-nine percent (330 of 561) were low-grade injuries of which 169 were grade I injuries and 161 were grade II injuries. Forty-one percent were high-grade injuries comprised of 136 grade III, 76 grade IV, and 19 grade V injuries. Table I shows the demographic data for all liver injuries by grade of injury. Of interest, patients in all groups were of similar age. As the severity of the
Discussion
The liver remains the most commonly injured abdominal organ in blunt trauma patients.10 More than a decade has elapsed since Feliciano16 proposed nonoperative management for all hepatic injuries, regardless of grade or extent, in the presence of hemodynamic stability. Subsequently, this concept has been expanded to include those who regain hemodynamic stability after arrival to the trauma center.8 Historically, nonoperative management of grades I, II, and III hepatic injuries has been widely
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Presented at the 62nd Annual Meeting of the Central Surgical Association, Tucson, Arizona, March 10-15, 2005.