title: Blunt liver trauma at sunnybrook Medical Centre: a 13 year experience.
abstract: Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive. A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in 132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated conservatively (n = 3) or died during resuscitation (n = 8). Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or hematoma accounting for 11 of 14 operations. The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II or III liver trauma according to Moore's classification with a mortality of 12% (n = 32). The remaining 18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86 deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for 1 (1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of 335 patients (14% overall). Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma in our population of multiply injured patients from 12% (1976-1983) down to 7% (1985-1989); with a gradual decline in overall mortality from 32% (1976-1983) to 19% (1985-1989), whereas the percentage of deaths due to head injuries and liver injury have increased.
authors.affiliation: Department of Surgery, Sunnybrook Medical Centre, University of Toronto, Ontario, Canada.
authors.forename: S S
authors.initials: SS
authors.lastname: Hanna
authors.forename: G
authors.initials: G
authors.lastname: Pagliarello
authors.forename: G
authors.initials: G
authors.lastname: Taylor
authors.forename: H
authors.initials: H
authors.lastname: Miller
authors.forename: H M
authors.initials: HM
authors.lastname: Scarth
authors.forename: F
authors.initials: F
authors.lastname: Brenneman
mesh_terms: D002423:Cause of Death; D003131:Combined Modality Therapy; D004322:Drainage; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000628:therapy
chemical_list: D006490:Hemostatics