Trends in the management of hepatic injury.
BACKGROUND
Options for management of blunt hepatic injury have broadened to include both operative management (OM) and nonoperative management (NOM). We identify trends in evaluation and management of blunt hepatic injury at a level 1 trauma center.


METHODS
Charts of 106 patients with blunt hepatic injuries from July 1, 1991 to June 30, 1995 were reviewed for method of abdominal evaluation (computed tomography versus DPL), injury severity score, liver injury grade, method of management, length of stay (LOS), transfusion requirements, complications, and outcome.


RESULTS
Nonoperative management steadily increased to 86%. Successful NOM occurred in 96% (48 of 50) and was not related to injury grade. Transfusion requirements were significantly greater in the group with OM versus those with NOM (11.3 versus 2.7). Patients with NOM also had significantly shorter intensive care unit stay and total LOS.


CONCLUSIONS
The majority of patients with blunt liver injury can be successfully managed nonoperatively regardless of injury grade. Nonoperative management may allow decreased resource utilization because of shorter hospital stays and decreased transfusion requirements.
Brasel
K J
KJ
Department of Surgery, St. Paul-Ramsey Medical Center, University of Minnesota, 55101, USA.
DeLisle
C M
CM
Olson
C J
CJ
Borgstrom
D C
DC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008875:Middle Aged; D014949:Wounds, Nonpenetrating / Q000628:therapy*