Successful nonoperative management of the most severe blunt liver injuries: a multicenter study of the research consortium of new England centers for trauma
Author Department
Surgery
Document Type
Article, Peer-reviewed
Publication Date
5-1-2012
Abstract
HYPOTHESIS: Grade 4 and grade 5 blunt liver injuries can be safely treated by nonoperative management (NOM). DESIGN: Retrospective case series. SETTING: Eleven level I and level II trauma centers in New England. PATIENTS: Three hundred ninety-three adult patients with grade 4 or grade 5 blunt liver injury who were admitted between January 1, 2000, and January 31, 2010. MAIN OUTCOME MEASURE: Failure of NOM (f-NOM), defined as the need for a delayed operation. RESULTS: One hundred thirty-one patients (33.3%) were operated on immediately, typically because of hemodynamic instability. Among 262 patients (66.7%) who were offered a trial of NOM, treatment failed in 23 patients (8.8%) (attributed to the liver in 17, with recurrent liver bleeding in 7 patients and biliary peritonitis in 10 patients). Multivariate analysis identified the following 2 independent predictors of f-NOM: systolic blood pressure on admission of 100 mm Hg or less and the presence of other abdominal organ injury. Failure of NOM was observed in 23% of patients with both independent predictors and in 4% of those with neither of the 2 independent predictors. No patients in the f-NOM group experienced life-threatening events because of f-NOM, and mortality was similar between patients with successful NOM (5.4%) and patients with f-NOM (8.7%) (P = .52). Among patients with successful NOM, liver-specific complications developed in 10.0% and were managed definitively without major sequelae. CONCLUSIONS: Nonoperative management was offered safely in two-thirds of grade 4 and grade 5 blunt liver injuries, with a 91.3% success rate. Only 6.5% of patients with NOM required a delayed operation because of liver-specific issues, and none experienced life-threatening complications because of the delay.
Recommended Citation
van der Wilden GM, Velmahos GC, Emhoff T, Brancato S, Adams C, Georgakis G, Jacobs L, Gross R, Agarwal S, Burke P, Maung AA, Johnson DC, Winchell R, Gates J, Cholewczynski W, Rosenblatt M, Chang Y. Successful nonoperative management of the most severe blunt liver injuries: a multicenter study of the research consortium of new England centers for trauma Arch Surg 2012 May;147(5):423-8.