Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-18T12:16:43.495Z Has data issue: false hasContentIssue false
  • English
  • Français

Management of Traumatic Liver Injuries without a Valid Trauma System

Published online by Cambridge University Press:  28 June 2012

Amir Khorram-Manesh  and
B. Pourseidi
Amir Khorram-Manesh*
Affiliation:
1Prehospital and Disaster Medicine Center, Gothenburg, Sweden
B. Pourseidi
Affiliation:
2Department of Surgery, Kerman University of Medical Science, Kerman, Iran
*
Prehospital and Disaster Medicine CenterSvangatan 4Regionens HusSE-405Gothenburg, Sweden E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Despite a global increase in conservative treatment of blunt liver injuries, the number of surgically treated traumas in one major trauma center in Iran has increased. The aim of this study was to unveil the reasons behind this increase in operative management by studying 228 consecutive patients at this regional center.

Hypothesis:

The increased number of liver injuries operated upon is due to the lack of a solid, well-defined trauma system.

Methods:

A retrospective review of all patients admitted for liver trauma at Bahonar Hospital, Kerman, Iran, from March 2001 until March 2006 was conducted. Patient data were collected, studied and statistically processed with regard to demographics, clinical and laboratory findings, surgical procedures, complications, and mortality.

Results:

All patients who were admitted between 30–360 minutes after injury were included. Twelve hemodynamically stable patients were treated conservatively in an ordinary surgical ward.The remaining 216 patients, 153 of whom had blunt injuries, were hemodynamically unstable. A total of 70 patients were in hemorrhagic shock at the time of arrival. Hemodynamically unstable patients with either the suspicion of associated injuries and/or who displayed clinical deterioration and could not be observed in an ordinary surgical ward were treated surgically. The majority of patients who were operated upon in this series had a grade-II liver injury. The total mortality rate in surgically treated patients was 18.1%. None of the patients treated conservatively died.

Conclusions:

Despite the low grade of their liver injuries, the high number of surgically treated patients in this series was due to the absence of a valid trauma system. This result should encourage the authorities to review current trauma systems and trauma surgical guidelines.

Keywords

liver injurymanagementprehospital caretraumatrauma system
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 4 , August 2009 , pp. 349 - 355
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Romano, L, Giovine, S, Guidi, G, et al. : Hepatic findings and considerations based on our experience in emergency diagnostic imaging. Eur Radiol 2004; 50:59–66.CrossRefGoogle ScholarPubMed
2Beckingham, IJ: ABC of diseases of liver, pancreas and biliary system: Liver and pancreatic trauma. BMJ 2001;322:783–785.CrossRefGoogle ScholarPubMed
3Parks, RW, Chrysos, E, Diamond, T: Management of liver trauma. Br J Surg 1999;86:1121–1135.CrossRefGoogle ScholarPubMed
4Schweiser, W, Tanner, S, Baer, HU, et al. : Management of traumatic liver injuries. Br J Surg 1993;80:86–88.CrossRefGoogle Scholar
5Stewart, BT, Lee, V, Danne, PD: Laparotomy for trauma in a regional center: the effect of delay on outcome. Aust N Z J Surg 1994;64:484–487.CrossRefGoogle Scholar
6Feliciano, DV, Mattox, KL, Jordan, GL et al. : Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann Surg 1986;204:438–445.CrossRefGoogle ScholarPubMed
7Wilson, RH, Moorehead, RJ: Hepatic trauma and its management. Injury 1991;22:439–445.CrossRefGoogle ScholarPubMed
8Krige, JE, Bornman, PC, Terblanche, J: Liver trauma in 446 patients. S Afr J Surg 1997;35:10–15.Google ScholarPubMed
9Brammer, RD, Bramhall, SR, Mirza, DF et al. : A 10 years experience of complex liver trauma. Br J Surg 2002;89:1532–1537.CrossRefGoogle Scholar
10Yoon, W, Jeong, YY, Kim, JK, et al. : CT in blunt liver trauma. Radiographic 2005;25:87–104.CrossRefGoogle ScholarPubMed
11Wemyss-Holden, SA, Bruening, M, Launois, B, Maddern, GJ: Management of liver trauma with implication for the rural surgeon. ANZ J Surg 2002;72:400–404.CrossRefGoogle ScholarPubMed
12American College of Surgeons Committee on Trauma: Advanced Trauma Life Support Manual. 6th ed.Chicago: American College of Surgeons, 1997.Google Scholar
13Mischinger, HJ, Bacher, H, Werkgartner, G et al. : Liver Trauma. Acta Chir Austriaca 1999;31:80–84.CrossRefGoogle Scholar
14Gao, JM, Du, DY, Zhao, XJ, et al. : Liver trauma: Experience in 348 cases. World J Surg 2003;27:703–708.CrossRefGoogle ScholarPubMed
15Zafarghandi, MR, Saeed Moghadegh, MH, Roudsari, BS: Preventable trauma death in Tehran: An estimate of trauma care quality in teaching hospitals. J Trauma 2003;55:459–465.CrossRefGoogle ScholarPubMed
16Moini, M, Rezaishiraz, H, Zafarghandi, M: Characteristics and outcome of injured patients treated in urban trauma centers in Iran. J Trauma 2000;48:503–507.CrossRefGoogle ScholarPubMed
17Hess, DR: Retrospective studies and chart reviews. Respir Care 2004;49:1171–1174.Google ScholarPubMed
18Harrington, DT, Connolly, M, Biffl, WL et al. : Transfer times to definitive care facilities are too long: A consequence of an immature trauma system. Ann Surg 2005;241:961–966.CrossRefGoogle Scholar
19Boone, DC, Federle, M, Billiar, TR et al. : Evolution of management of major hepatic trauma: Identification of patterns of injury. J Trauma 1995;39:344–350.CrossRefGoogle ScholarPubMed
20Arreola-Risa, C., Mock, CN, Lojero-Wheatly, L et al. : Low cost improvement in prehospital trauma care in a Latin American city. J Trauma 2000;48:119–124.CrossRefGoogle Scholar
21Brehaut, JC, Poses, R, Shojania, KG et al. : Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol. Implement Sci 2007;2:18.CrossRefGoogle ScholarPubMed
22Malhotra, AK, Fabian, TC, Croce, MA et al. : Blunt hepatic injury: A paradigm shift from operative to non-operative management in the 1990s. Ann Surg 2000;231:804–813.CrossRefGoogle Scholar
23Talving, P, Beckman, M, Haggmark, T et al. : Epidemiology of liver injuries. Scand J Surg 2003;92:192–194.CrossRefGoogle ScholarPubMed
24Coughlin, PA, Stringer, MD, Lodge, JPA et al. : Management of blunt liver trauma in a tertiary referral center. Br J Surg 2004;91:317–321.CrossRefGoogle Scholar
25Ertekin, C., Akyildiz, H: Results of conservative treatment for solid abdominal organ trauma. Ulus Travma Derg 2001;7:224–230.Google ScholarPubMed
26Cox, E, Flancbaum, L, Dauterive, AH et al. : Blunt trauma to the liver. Ann Surg 1988;207:126–134.CrossRefGoogle ScholarPubMed
27Gupta, SS, Ahluwalia, SM, Anantharam, P: Liver trauma (management in 105 consecutive cases). J Postgrad Med 1990;36:131–135.Google ScholarPubMed
28Dane, TM, Como, JJ, Bochicchio, GV et al. : Reevaluating the management and outcome of severe blunt liver injury. J Trauma 2004;57:494–500.CrossRefGoogle Scholar
29Peleg, K, Abrahamson-Daniel, L, Stein, M et al. : Increased survival among severe trauma patients. Arch Surg 2004;139:1231–1236.CrossRefGoogle ScholarPubMed
30Noland, RB, Mohammed, AQ: Improvements in medical care and technology and reductions in traffic related fatalities in Great Britain. Accid Anal Prev 2004;36:103–113.CrossRefGoogle ScholarPubMed
31Demetriadis, D, Martin, M, Salim, A et al. : The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 2005;242(4):512–517.CrossRefGoogle Scholar
32Demetriades, D, Hadjizacharia, P, Constantinou, C. et al. : Selective non-operative management of penetrating abdominal solid organ injuries. Ann Surg 2006;245(4):620–628.Google Scholar
33Sikhondze, WL, Madiba, TE, Naidoo, NM et al. : Predictors of outcome in patients requiring surgery for liver trauma. Injury 2007;38:65–70.CrossRefGoogle ScholarPubMed