Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries.
During a 5-year period, 482 patients with liver injuries were studied prospectively: 65% resulted from penetrating and 35% from blunt injuries. The injuries were graded by the hepatic injury scale (grades I to VI); transfusion requirements and perihepatic abscesses correlated with increasing scores. Minor surgical techniques were needed in 338 patients and 144 patients required major techniques. Omental packing was used in 60% of the major injuries and yielded 7% mortality and 8% abscess rates. Gauze packs were used for management of 10% of major injuries and yielded 29% mortality and 30% abscess rates. The patients were randomized to no drain, closed suction, or sump drainage and respective perihepatic abscess rates were 6.7%, 3.5%, and 13% (p less than 0.03; suction compared to closed suction). Multivariate analysis demonstrated increasing abdominal trauma indices and transfusion requirements as well as sump drainage to be associated independently with perihepatic infection.
Fabian
T C
TC
Department of Surgery, University of Tennessee, Memphis.
Croce
M A
MA
Stanford
G G
GG
Payne
L W
LW
Mangiante
E C
EC
Voeller
G R
GR
Kudsk
K A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications / Q000401:mortality; D004322:Drainage / Q000379:methods; D006801:Humans; D008099:Liver / Q000293:injuries*; D008100:Liver Abscess / Q000209:etiology; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D013396:Suction; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery*