A successful multimodality strategy for management of liver injuries

The treatment of liver injuries involves many strategies ranging from obser vation to operative intervention and includes numerous options such as angi ography, packing, and damage-control procedures. In July 1994 we instituted a protocol for the management of traumatic liver injuries. The main object ive of this study was to evaluate the management of liver injuries occurrin g since the institution of the protocol. Two hundred three consecutive adul t patients with liver injuries were evaluated at our Level I trauma center between July 1994 and May 1999, Eighty-eight per cent of the injuries were blunt with a mean Injury Severity Score (ISS) of 24.3 +/- 0.8 and a surviva l probability (Ps) of 90.0 +/- 1.5 per cent. The overall mortality was 6.4 per cent. A comparison between patients with minor liver injuries and patie nts with more severe injuries [Abbreviated Injury Score (AIS) <3 vs >3] dem onstrated no difference in mortality between the two groups despite a Ps of 93.8 +/- 1.3 per cent in patients with an AIS <3 versus 84.1 +/- 3.3 per c ent in patients with an AIS >3. The most common complication in our patient population was posthemorrhagic anemia, which was seen in 10.8 per cent of cases. Severity of injury did not result in a significant difference in the complication rate. Patients who underwent laparotomy had a statistically h igher ISS, a lower Ps, and a mortality rate of 11.5 per cent compared with 3.7 per cent (P = 0.03) in patients managed nonoperatively. However, a comp arison of patients undergoing laparotomy with those who did not and who had equivalent ISS demonstrated no difference in mortality. Our results demons trated that a preplanned management strategy was a successful way in which to treat patients with traumatic liver injuries, Although nonoperative mana gement of liver injuries has been common practice a management plan that in volves a multimodal surgical strategy is essential.