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European Journal of Trauma and Emergency Surgery

Published in:

01-02-2015 | Original Article

Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

Authors: K. A. Bertens, K. N. Vogt, R. Hernandez-Alejandro, D. K. Gray

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2015

Abstract

Purpose

A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE).

Methods

A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality.

Results

We identified 396 patients with a mean ISS of 33 (±14). Sixty-two (18 %) patients had severe liver injuries (≥AAST grade IV). OM occurred in 109 (27 %) patients. Logistic regression revealed high ISS (OR 1.07; 95 % CI 1.05−1.10), and lower systolic blood pressure on arrival (OR 0.98; 95 % CI 0.97−0.99) to be associated with OM. The overall mortality was 17 %. Older patients (OR 1.05; 95 % CI 1.03−1.07), those with high ISS (OR 1.11; 95 % CI 1.08−1.14) and those requiring OM (OR 2.89; 95 % CI 1.47−5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23 %) and AE (29 %) groups (p = 0.32). Only 3 % of those with NOM experienced morbidity.

Conclusions

The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

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Title: Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?
Authors: K. A. Bertens
K. N. Vogt
R. Hernandez-Alejandro
D. K. Gray
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2015
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-014-0431-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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