title: Nonoperative management reduces the overall mortality of grades 3 and 4 blunt liver injuries.
abstract: Nonoperative (NON-OP) management has been accepted as the treatment of choice for stable patients sustaining blunt liver injury. The objectives were to evaluate the results and changes in the treatment of grades 3 and 4 liver injuries and to determine the impact of NON-OP management on mortality. This was a retrospective review of all grade 3 and 4 blunt liver injuries treated during a 15-year period. One-hundred and twenty-eight consecutive patients (27 NON-OP) were analyzed. Thirty-four patients died in the OP group (33.7%). Nonsurvivors were older (28 versus 39 years), had lower revised trauma score (RTS), higher injury severity score (ISS), and higher transfusion requirements. Six patients failed NON-OP management (22.2%). The mortality rate in the NON-OP group was 0%. NON-OP was associated with a 23.5% reduction in mortality. Unnecessary OP management of grades 3 and 4 liver injuries should be discouraged.
authors.affiliation: Division of Trauma, Critical Care, and Burns, Department of Surgery, University of California San Diego, San Diego, California 92103-8896, USA. rcoimbra@ucsd.edu
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: David B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: Sandra
authors.initials: S
authors.lastname: Engelhart
authors.forename: Dale
authors.initials: D
authors.lastname: Fortlage
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000628:therapy*