EVOLUTION IN THE MANAGEMENT OF THE COMPLEX LIVER-INJURY AT A LEVEL-I TRAUMA CENTER

Background: Management of the severe liver injury evolved from mandato ry surgical repair to a more selective approach, This paper reviews th e changes in management of the severe liver injury at a Level I trauma center. Methods: We reviewed the records of patients with severe live r injury admitted to a Level I trauma center between January 1984 and December 1995, The patients were divided into two groups, G1 and G2, b ased on their date of admission before or after January 1991, The two groups were compared for blood products use, management of the liver i njury, and outcome. Results: One hundred six patients were compared fo r age, sex, Acute Physiology and Chronic Health Evaluation II score, I njury Severity Score, abdominal Abbreviated Injury Scale score, and th e presence of concomitant injuries. There was no difference in managem ent or outcome of the victims of penetrating injury between G1 and G2 (n = 48), The blunt injury patients in G1 (n = 22) had more liver surg ery (p = 0.006), blood transfusion (p = 0.040), intra-abdominal sepsis (6 vs. 0), and higher mortality (p = 0.041) than those in G2 (n = 36) . Conclusion: Isolated severe blunt liver injury may be managed nonope ratively with better survival and less blood products use.