Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 3, Number 1, February 2010, pages 9-18


Treatment of Liver Trauma: Operative or Conservative Management

Figure

Figure 1.
Figure 1. Management and mortality.

Tables

Table 1. Distribution of Mortality by Type of Initial Treatment (Operative, Conservative and Failure) and Grade of the Injury
 
GradeOperativeConservativeFailureTotal Mortality
N (%)Mortality*N (%)Mortality*N (%)†
*Percentage of mortality by initial treatment group and grade of injury
Percentage of mortality by grade of injury.
**Number total of patients by group (operative, conservative and failure)
#one patient in each group (grade II and V) died in conservative treatment failure
I (n = 23)5 (21.7)-18 (78.3)---
II (n = 34)12 (35.3)3 (25)22 (64.7)2 (9.1)1 (4.5)#6 (14.7)
III (n = 56)22 (39.3)3 (13.6)34 (60.7)-6 (17.6)3 (5.3)
IV (n = 19)8 (42.1)4 (50)11 (57.9)1 (9.1)4 (36.4)5 (26.3)
V (n = 11)9 (81.8)6 (66.6)2 (18.2)1 (50)2 (100)#8 (63.6)
Total:56** (39.2)16 (28.5)87** (60.8)4 (4.5)13**22 (15.3)

 

Table 2. Summary of Outcome by Treatment Group
 
OperativeConservative†TotalFailure
N=56 (%)N=87 (%)N=143 (%)N=13 (%)
*12 patients died during the first 48 hours.
On data analysis of the conservative group, the group of failure of conservative treatment was included.
Morbidity
  YES20 (35.7)10 (11.5)30 (20.9)5 (38.5)
  NO36 (64.3)77 (88.5)113 (79.1)8 (61.5)
Mortality
  YES16 (28.6)*4 (4.5)20 (13.9)*2 (15.4)
  NO40 (71.4)83 (95.5)123 (86.1)11 (84.6)
Stay20.4 ± 22.315.2 ± 12.917.3 ± 17.116.1 ± 9.5

 

Table 3. Risk factors for treatment by Uni-multivariante Analysis
 
Univariante Analysis
*Values expressed as mean ± standard deviation. Abbreviations: ISS: injury severity score; RBC: red blood cell; FFP: fresh frozen plasma; PLT: Platelet, OR: odds ratio; CI: confidence interval.
VariableFinal conservative management (n =74)Final surgical treatment (n = 69)P
Initial injury grade< 0.0001
  No injury132
  I174
  II225
  III2720
  IV76
  V02
Final injury grade< 0.0001
  I185
  II2113
  III2828
  IV712
  V011
Morbidity< 0.0001
  Yes525
  No6944
Mortality< 0.0001
  Yes218
  No7251
Hepatic Mortality< 0.0001
  Yes113
  No7356
ISS *23.1 ± 1530.1 ± 13.1< 0.0001
RBC *5.2 ± 7.511.2 ± 10.60.002
FFP *0.4 ± 1.62.6 ± 3.1< 0.0001
PLT *0.02 ± 0.10.5 ± 1.1< 0.0001
Multivariante Analysis (Multiple Logistic Regression Model)
*Values expressed as mean ± standard deviation. Abbreviations: ISS: injury severity score; RBC: red blood cell; FFP: fresh frozen plasma; PLT: Platelet, OR: odds ratio; CI: confidence interval.
VariablepOR95% CI
Inicial grade injury< 0.00013.82.057.08
Final grade injury< 0.00010.20.080.4

 

Table 4. Comparison of Patients With Low and High Injury Grade
 
*Values expressed as mean ± standard desviation
Abbreviations: RBC: red blood cell; FFP: fresh frozen plasma; PLT: Platelet, OR: odds ratio; CI: confidence interval
Univariante Analysis
VariableGrade I-II-IIIGrade IV-VP
Hemodynamic instability0.008
  Yes2319
  No234
Vascular injury0.001
  Yes07
  No4616
Surgical technique< 0.0001
  Exploratory laparotomy131
  Packing08
  Vascular suture205
  Electrocoagulation60
  Hepatic resection69
Pringle< 0.0001
  Yes415
  No428
Mortality0.005
  Yes711
  No3912
Hepatic mortality< 0.0001
  Yes310
  No4313
Hemoperitoneum*1377 ± 8972939 ± 1351< 0.0001
Lesion size *5.1 ± 2.29 ± 2.8< 0.0001
RBC *6.2 ± 6.518.7 ± 12.3< 0.0001
FFP *.1.1 ± 2.33.03 ± 3< 0.0001
PLT *0.07 ± 0.31.1 ± 1.9< 0.0001
Hospital Stay18.9 ± 18.111.4 ± 10.70.003
Multivariante Analysis (Multiple Logistic Regression Model)
*Values expressed as mean ± standard desviation
Abbreviations: RBC: red blood cell; FFP: fresh frozen plasma; PLT: Platelet, OR: odds ratio; CI: confidence interval
VariablepOR95 % CI
Hemoperitoneum0.02111
Lesion size0.0132.81.26.4

 

Table 5. Comparison of Patients in Two Periods
 
Variable1992-1999
N = 88 (%)
2000-2008
N = 55 (%)
P
*Values expressed as mean ± standard desviation
Abbreviations: ISS: injury severity score; DPL: diagnostic peritoneal lavage; RBC: red blood cell; FFP: fresh frozen plasma; PLT: Platelet
Age (yrs)*30.8 ± 1333.9 ± 17.10.441
Male sex68 (77.3)46 (83.6)0.242
Hospital stay*15.1 ± 13.420.8 ± 21.30.071
ISS*25.8 ± 12.225.8 ± 11.80.896
Etiology0.038
  Traffic accidents60 (68.2)45 (81.8)
  Stab wounds14 (15.9)1 (1.8)
  Falls10 (11.4)6 (10.9)
  Firearms3 (3.4)0 (0)
  Others1 (1.1)3 (5.5)
Diagnostic technique< 0.0001
  No8 (9.1)0 (0)
  Ultrasound72 (81.8)16 (29.1)
  TC4 (4.55)39 (70.9)
  DPL*4 (4.55)0 (0)
Injury grade0.022
  I8 (9.1)15 (27.3)
  II20 (22.7)14 (25.5)
  III40 (45.5)16 (29.1)
  IV11 (12.5)8 (14.5)
  V9 (10.2)2 (3.6)
Abdominal injuries0.092
  Yes32 (36.4)27 (49.1)
  No56 (63.6)28 (50.9)
Extrabdominal injuries0.041
  Yes61 (69.3)9 (16.4)
  No27 (30.7)46 (83.6)
Hemodynamic inestability31 (35.2)15 (27.3)0.211
Treatment0.077
  Nonoperative management49 (55.7)38 (69.1)
  Surgery39 (44.3)17 (30.9)
Surgical technique0.087
  Exploratory laparotomy9 (10.2)5 (9.1)
  Packing3 (3.4)5 (9.1)
  Vascular suture21 (23.8)4 (7.3)
  Electrocoagulation5 (5.7)1 (1.8)
  Hepatic resection6 (6.8)9 (16.4)
Failure of conservative treatment8 (16.3)5 (13.1)0.482
Morbidity0.015
  Yes24 (27.3)6 (10.9)
  No64 (72.7)49 (89.1)
Mortality0.532
  Yes12 (13.6)8 (14.5)
  No76 (86.4)47 (85.5)
Hepatic Mortality0.534
  Yes9 (10.2)5 (9.1)
  No79 (89.8)50 (90.9)
RBC *7.6 ± 8.213.7 ± 12.30.033
FFP *1.3 ± 2.62.4 ± 2.60.003
PLT *0.3 ± 1.90.8 ± 0.9< 0.0001