TRENDS IN THE MANAGEMENT OF HEPATIC-INJURY

BACKGROUND: Options for management of blunt hepatic injury have broade ned to include both operative management (OM) and nonoperative managem ent (NOM). We identify trends in evaluation and management of blunt he patic injury at a level 1 trauma center. METHODS: Charts of 106 patien ts with blunt hepatic injuries from July 1, 1991 to June 30, 1995 were reviewed for method of abdominal evaluation (computed tomography vers us DPL), injury severity score, liver injury grade, method of manageme nt, length of stay (LOS), transfusion requirements, complications, and outcome. RESULTS: Nonoperative management steadily increased to 86%. Successful NOM occurred in 96% (48 of 50) and was not related to injur y grade. Transfusion requirements were significantly greater in the gr oup with OM versus those with NOM (11.3 versus 2.7). Patients with NOM also had significantly shorter intensive care unit stay and total LOS . CONCLUSIONS: The majority of patients with blunt liver injury can be successfully managed nonoperatively regardless of injury grade. Nonop erative management may allow decreased resource utilization because of shorter hospital stays and decreased transfusion requirements. (C) 19 97 by Excerpta Medica, Inc.