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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2018

Open Access 01-02-2018 | Original Article

Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation

Authors: J. Barrie, S. Jamdar, M. F. Iniguez, O. Bouamra, T. Jenks, F. Lecky, D. A. O’Reilly

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2018

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Abstract

Background

Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival.

Methods

Patients sustaining hepatic trauma were identified using the Trauma Audit and Research Network database. Demographics, management and outcomes were assessed between January 2005 and December 2014 and analysed over five, 2-year study periods. Independent predictor variables for the outcome of liver trauma were analysed using multiple logistic regression.

Results

4368 Patients sustained hepatic trauma (with known outcome) between January 2005 and December 2014. Median age was 34 years (interquartile range 23–49). 81% were due to blunt and 19% to penetrating trauma. Road traffic collisions were the main mechanism of injury (58.2%). 241 patients (5.5%) underwent liver-specific surgery. The overall 30-day mortality rate was 16.4%. Improvements were seen in early consultant input, frequency and timing of computed tomography (CT) scanning, use of tranexamic acid and 30-day mortality over the five time periods. Being treated in a unit with an on-site HPB service increased the odds of survival (odds ratio 3.5, 95% confidence intervals 2.7–4.5).

Conclusions

Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.
Literature
1.
2.
Peden M, McGee K, Krug E. Injury: a leading cause of the global burden of disease 2000. Geneva: World Health Organization; 2002.
3.
Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232(3):324.CrossRef
4.
Di Saverio S, Catena F, Filicori F, Ansaloni L, Coccolini F, Keutgen XM, et al. Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre. Injury. 2012;43(9):1347–54.CrossRefPubMed
5.
Scollay JM, Beard D, Smith R, McKeown D, Garden OJ, Parks R. Eleven years of liver trauma: the Scottish experience. World J Surg. 2005;29(6):744–9.CrossRefPubMed
6.
Chien L-C, Lo S-S, Yeh S-Y. Incidence of liver trauma and relative risk factors for mortality: a population-based study. J Chin Med Assoc. 2013;76(10):576–82.CrossRefPubMed
7.
Prichayudh S, Sirinawin C, Sriussadaporn S, Pak-art R, Kritayakirana K, Samorn P, et al. Management of liver injuries: predictors for the need of operation and damage control surgery. Injury 2014;45(9):1373–7.CrossRefPubMed
8.
Petrowsky H, Raeder S, Zuercher L, Platz A, Simmen H, Puhan M, et al. A quarter century experience in liver trauma: a plea for early computed tomography and conservative management for all hemodynamically stable patients. World J Surg. 2012;36(2):247–54.CrossRefPubMed
9.
van der Wilden GM, Velmahos GC, Emhoff T, Brancato S, Adams C, Georgakis G, et al. 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;147(5):423–8.PubMed
10.
Schnüriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg. 2009;96(1):104–10.CrossRefPubMed
11.
Hurtuk M, Lawrence Reed I R, Esposito TJ, Davis KA, Luchette FA. Trauma surgeons practice what they preach: the NTDB story on solid organ injury management. J Trauma Acute Care Surg. 2006;61(2):243–55.CrossRef
12.
Hommes M, Navsaria PH, Schipper IB, Krige J, Kahn D, Nicol AJ. Management of blunt liver trauma in 134 severely injured patients. Injury. 2015;46(5):837–42.CrossRefPubMed
13.
Chen R-J, Fang J-F, Lin B-C, Hsu Y-P, Kao J-L, Chen M-F. Factors determining operative mortality of grade V blunt hepatic trauma. J Trauma Acute Care Surg. 2000;49(5):886–91.CrossRef
14.
Demetriades D, Martin M, Salim A, Rhee P, Brown C, Doucet J, et al. Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (injury severity score > 15). J Am Coll Surg. 2006;202(2):212–5.CrossRefPubMed
15.
Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L. The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg. 2005;242(4):512.PubMedPubMedCentral
16.
Wong TH, Lumsdaine W, Hardy BM, Lee K, Balogh ZJ. The impact of specialist trauma service on major trauma mortality. J Trauma Acute Care Surg. 2013;74(3):780–4.CrossRefPubMed
17.
18.
19.
O’Reilly D, Bouamra O, Kausar A, Malde D, Dickson E, Lecky F. The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989–2013. Ann R Coll Surg Engl. 2015;97(2):125–30.CrossRefPubMedPubMedCentral
20.
Sikhondze WL, Madiba TE, Naidoo NM, Muckart DJJ. Predictors of outcome in patients requiring surgery for liver trauma. Injury. 2007;38(1):65–70.CrossRefPubMed
21.
22.
Polanco PM, Brown JB, Puyana JC, Billiar TR, Peitzman AB, Sperry JL. The swinging pendulum: a national perspective of nonoperative management in severe blunt liver injury. J Trauma Acute Care Surg. 2013;75(4):590–5.CrossRefPubMed
23.
Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003;138(5):475–81.CrossRefPubMed
24.
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.CrossRefPubMed
25.
Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):S288–S93.CrossRefPubMed
26.
Collaborators C-. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771): 1096–101.
27.
Metcalfe D, Bouamra O, Parsons N, Aletrari MO, Lecky F, Costa M. Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres. Br J Surg. 2014;101(8):959–64.CrossRefPubMed
Metadata
Title
Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation
Authors
J. Barrie
S. Jamdar
M. F. Iniguez
O. Bouamra
T. Jenks
F. Lecky
D. A. O’Reilly
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0765-y

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