Predictive factors of liver injury in blunt multiple trauma.
BACKGROUND
This study was conducted to clarify whether injuries that are likely to be revealed by initial clinical and conventional radiological examination at the trauma bay (e.g., right-side rib fractures) meaningfully contribute to the prior probability of accompanying hepatic lesions in multiple injured patients.


METHODS
Fifty-five subjects (sampled from a cohort of 218 patients) with liver injury fulfilling the definition of polytrauma were compared with 55 polytrauma patients without liver injury. Controls were individually matched for age, gender, and Injury Severity Scores. Whole-body, helical, contrast-enhanced computed tomography was applied to all participants. We modeled independent predictors of liver involvement by conditional logistic and random-effects regression analysis.


RESULTS
In the present sample, the prevalence of hepatic injury was 25.2%. Neither the injury mechanism (car crash, pedestrian accident, fall from height) nor certain accompanying injuries (right-side serial rib fractures, lumbar spine fractures) predicted the presence of hepatic injury. Liver injury was particularly unlikely in bikers [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.59-1.03] and patients with left-side rib fractures (OR 0.80, 95% CI 0.66-0.98).


CONCLUSIONS
There are no index injuries that will reliably indicate the presence of liver involvement in multiple trauma cases. Also, the absence of these injuries cannot rule out liver damage.
Matthes
Gerrit
G
Department of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Trauma Center, Warener Str. 7, 12683, Berlin, Germany. gerrit.matthes@uni-greifswald.de
Stengel
Dirk
D
Bauwens
Kai
K
Seifert
Julia
J
Rademacher
Grit
G
Mutze
Sven
S
Ekkernkamp
Axel
A
D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D001642:Bicycling / Q000293:injuries; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D015999:Multivariate Analysis; D016017:Odds Ratio; D012253:Rib Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D036542:Tomography, Spiral Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery