Outcome and management of blunt liver injuries in multiple trauma patients

Background: In Germany, abdominal trauma in multiple-trauma patients can be observed in about 25-35% of all cases. Due to major bleeding complications , the initial treatment of blunt abdominal trauma in multiple-trauma patien ts has high priority. The aim of this study was to discuss management, trea tment and outcome of blunt liver injury in multiple-trauma patients treated in our department. Methods: The clinical records of 1192 multiple-trauma p atients [injury severity score (ISS) 3-18] treated at the Surgical Departme nt of the University Clinic of Essen from January 1975 to February 1998 wer e reviewed. Seventy-five patients with an ISS above 18 operated on due to a blunt liver injury could be included. The mean age was 29.82+/-1.80 years (60 males and 15 females). The degree of injury in this group was high (ISS 37.12+/-1.06). Results: Twenty-three of the 75 (30.6%) patients died durin g their hospital stay. Deceased patients were older (27+/-2 years versus 37 +/-4 years; P<0.01) and had a higher ISS (ISS=34.5+/-1 versus 43.2+/-2; P<0 .01). In nine cases, death was strongly related to liver injury. Operationa l blood loss was higher in the group of multiply injured patients with live r injury and in those patients who did not survive (P<0.05). An increased m ortality could be seen in this selected patient group when compared with ou r large collective of multiply injured patients. The age of the patients, t he ISS and operative blood loss were the significant factors that influence d the operative mortality after blunt hepatic injuries in our study.