Current approach to liver traumas

Area of Science:

• Trauma Surgery
• Hepatology
• Emergency Medicine

Background:

• Liver injuries present significant treatment challenges due to organ size and location.
• Surgical intervention for liver trauma carries high mortality rates, necessitating careful consideration of clinical factors.
• Hemodynamic status is a critical determinant for surgical decision-making in liver trauma management.

Purpose of the Study:

• To describe a clinical approach to managing liver traumas.
• To emphasize the importance of conservative treatment strategies for hepatic injuries.
• To analyze factors influencing mortality and outcomes in liver trauma patients.

Main Methods:

• Retrospective analysis of 300 patients with liver trauma admitted between 2003 and 2013.
• Data collected included demographics, hepatic panel, coagulation tests (APTT, PT, INR, fibrinogen), and biochemistry.
• Patient stability, injury grade (American Association for the Surgery of Trauma Organ Injury Scale), and treatment (conservative vs. surgical) were assessed.

Main Results:

• Overall mortality rate was 13% (40/300 patients).
• Hemodynamic instability on admission was a major factor in mortality.
• High AST, ALT, LDH, INR, creatinine, and low fibrinogen/platelet counts were associated with higher-grade injuries and mortality.

Conclusions:

• Patient stability is the primary factor guiding the management of hepatic injuries.
• Stable patients with reliable examinations can be managed nonoperatively.
• Unstable patients necessitate surgical intervention; a non-operative approach is preferred when feasible.