title: Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography.
abstract: The estimated prevalence of liver injury in patients with blunt multiple trauma ranges from 1% to 8%. The objective of this study was to investigate the profile of accompanying liver injury in a cohort of polytraumatized patients who had regularly undergone contrast-enhanced, whole-body helical computed tomography (CT). We enrolled consecutive patients admitted between September 1997 and January 2001 to a level I trauma center. Clinical baseline data were compiled as part of a nationwide trauma registry. Morphologic features were evaluated descriptively, whereas prognostic variables were assessed by logistic regression analysis. We identified 218 patients [149 men, mean age 35 +/- 18 years, mean injury severity score (ISS) 35 +/- 10], 55 of whom had sustained blunt liver trauma [25.2%, 95% confidence interval (CI) 19.6-31.5%]. The prevalence of Moore III to V lesions was 10.1%. There were 99 parenchymal contusions, 15 capsular tears, and 2 liver fractures. Surgery was required in 15 patients and was best predicted by the classification of the American Association for the Surgery of Trauma [odds ratio (OR) 3.91, 95% CI 1.59-9.61]. The mortality rate was 0.0035/person/day. Patients requiring surgical repair had fourfold increased relative odds of case fatality (OR 4.50, 95% CI 1.01-19.96). Sevenfold increased relative odds were observed if liver laceration was considered the leading injury (OR 7.17, 95% CI 1.17-43.97). The prevalence of liver lacerations among multiple-trauma patients is likely to be underestimated and must be determined by the independent application of reference standards, such as helical CT. High-grade hepatic injuries and the need for surgical repair are associated with poorer survival prognosis.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin Trauma Center, Warener Strasse 7, 12683 Berlin, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Matthes
authors.forename: Dirk
authors.initials: D
authors.lastname: Stengel
authors.forename: Julia
authors.initials: J
authors.lastname: Seifert
authors.forename: Grit
authors.initials: G
authors.lastname: Rademacher
authors.forename: Sven
authors.initials: S
authors.lastname: Mutze
authors.forename: Axel
authors.initials: A
authors.lastname: Ekkernkamp
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015996:Survival Rate; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery