title: Risk factors for hepatic morbidity following nonoperative management: multicenter study.
abstract: OBJECTIVE
  Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified.
  
  
  METHODS
  Multicenter historical cohort.
  
  
  METHODS
  Seven urban level I trauma centers.
  
  
  METHODS
  Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours.
  
  
  METHODS
  Nonoperative treatment of complex blunt hepatic injuries.
  
  
  METHODS
  Complications and treatment strategies.
  
  
  RESULTS
  Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis.
  
  
  CONCLUSIONS
  Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.
authors.affiliation: University of Texas, Houston 77030, USA. rosemary.a.kozar@uth.tmc.edu
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Kozar
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.forename: C Clay
authors.initials: CC
authors.lastname: Cothren
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Matthew
authors.initials: M
authors.lastname: Sena
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Brian
authors.initials: B
authors.lastname: Eastridge
authors.forename: Eric
authors.initials: E
authors.lastname: Acheson
authors.forename: Susan I
authors.initials: SI
authors.lastname: Brundage
authors.forename: Monika
authors.initials: M
authors.lastname: Tataria
authors.forename: Mary
authors.initials: M
authors.lastname: McCarthy
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000453:epidemiology / Q000628:therapy*