title: Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy.
abstract: BACKGROUND
  The justification and preference for operative versus nonoperative management of hepatic injuries caused by blunt trauma remains ambiguous. This review assesses the outcome of operative and nonoperative management of liver injury after blunt trauma.
  
  
  METHODS
  We retrospectively reviewed the demographics, severity of injury, severity of liver injury, associated concomitant injuries, management scheme, and outcome of patients with documented hepatic injury from 1993 to 2003.
  
  
  RESULTS
  The overall mortality rate was 9.4%, with 3.7% caused by the liver injury itself. Fifty-nine percent (330 of 561) of liver injuries were of low severity (grades I and II), with an overall mortality rate of 6.6% caused by concomitant injuries and liver-related mortality of 0%. Forty-one percent (231 of 561) of liver injuries were high-severity injuries (grades III, IV, and V). Mortality for nonoperative management of high-severity liver injuries was 2.2%. If operative intervention was required because of hemodynamic instability or concomitant injuries then the mortality rate was significantly higher at 30%. Forty-two of the 378 (11%) liver injuries treated nonoperatively required an adjunctive procedure for successful management.
  
  
  CONCLUSIONS
  Selective management of liver injuries presented a low liver-related mortality rate. Low-grade injuries can be managed nonoperatively with excellent results. High-grade injuries can be managed nonoperatively, if operative intervention is not required for hemodynamic instability or associated injuries, with a low mortality. In these patients, adjunctive procedures will be required selectively for successful nonoperative management of high-grade liver injuries. High-grade injuries requiring operative management because of hemodynamic instability or concomitant injuries continue to have significantly higher mortality.
authors.affiliation: School of Medicine in Louisville, Department of Surgery, University of Louisville, Kentucky 40298, USA. xmasmd@yahoo.com
authors.forename: Ashley Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Wilson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Manning
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.forename: Frank B
authors.initials: FB
authors.lastname: Miller
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Rodriguez
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D006439:Hemodynamics; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000293:injuries*; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*