Liver injuries--improved results with a formal protocol including angiography.
OBJECTIVE
We hypothesised that a formal treatment protocol for liver injuries including angiography would increase the non-operative management (NOM) rate and would be efficient as an adjunct to damage control surgery.


METHODS
During the 4-year period from 1 August 2000, a total of 138 adult patients with liver injuries were admitted to the largest trauma centre in Norway and prospectively included in the institutional trauma registry. On 1 August 2002, a protocol mandating angiography in all NOM patients with OIS grades 3-5 liver injuries and after packing of the liver was implemented. All patients admitted during the subsequent 2-year period (group 2) were compared with the previous 2 years as historic controls (group 1).


RESULTS
Fifty-five patients were included in group 1 and 59 in group 2. The groups were statistically comparable, both with a mean ISS of 31. Patients selected for NOM increased from 28 (51%) to 45 (76%) (p<0.05), without increasing failure rate, liver-related complications, mortality or transfusion rate. Angiography was performed in 26 patients in group 2 (44%). Only nine patients underwent embolisation (35%), and five of these were in the NOM group. Angiography was negative in the eight NOM stable patients with OIS grade 3 injury.


CONCLUSIONS
The implementation of a formal NOM protocol decreased total laparotomy rate and seemed to improve patient outcome without jeopardising patient safety. Surprisingly few of the patients undergoing angiography required embolisation. Angiography is not indicated in stable OIS grade 3 liver injuries, and the protocol in our institution has been adjusted accordingly. AE seems to be a valuable adjunct to DCS with packing of liver injuries.
Gaarder
Christine
C
Trauma Unit, Emergency Division, Ullevaal University Hospital, N-0407 Oslo, Norway. tinagaar@online.no
Naess
Pål Aksel
PA
Eken
Torsten
T
Skaga
Nils Oddvar
NO
Pillgram-Larsen
Johan
J
Klow
Nils Einar
NE
Buanes
Trond
T
D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome