Changing times and the treatment of liver injury

We hypothesized that the frequency, diagnosis and treatment of liver injury have changed dramatically in the past 30 years. Patients with liver injuri es treated in an urban level I trauma center were analyzed for three separa te time periods, namely, 1969-1970, 1981-1982, and 1997-1998. The injuries were categorized by etiology; Abbreviated Injury Score severity, and type o f treatment, including observation (Ob), laparotomy without treatment of li ver injury (OR No Rx), suture repair (Sut), tractotomy with intraperipheral hemostasis (Tr), dearterialization (HAL), and resection (Re) (See Table, b elow). There were 249 patients in 1969-1970, 70, 79 in 1981-1982, and 116 i n 1997-1998. Stab wounds and gunshot wounds decreased from 235 patients in 1969-1970 to 61 patients in 1997-1998. Blunt injuries increased from 14 pat ients in 1969-1970 to 55 patients in 1997-1998. Major injuries (Abbreviated Injury Score 4-5) fell from 104 to 25 to 20 during the decade. Laparotomy was done in ail patients in 1969-1970 and 1981-1982, whereas most blunt inj uries were observed in 1997-1998; only 9 of 65 blunt injuries in 1997-1998 required hemostasis. [GRAPHICS] We conclude the following: 1) Central urban depopulation reduces experience with liver trauma, 2) abdominal CT increases the diagnosis of liver injury , and 3) observation of stable patients with blunt liver injury is now the standard.