Predictive factors of operative or nonoperative management of blunt hepatic trauma.
OBJECTIVE
Nonoperative management (NOM) has revolutionized the care of blunt hepatic trauma patients. The aim of the present study was to identify and evaluate the predictors of NOM of these patients.


METHODS
The Trauma Registry data of 55 consecutive adult patients admitted with blunt hepatic trauma over a 4-year period was reviewed. Patients were divided into immediately operated (OP-group) and selected for NOM (NOM-group). Factors analyzed were: demographics, injury mechanism, initial vital signs, liver injury grade, concomitant injuries, and total injury severity scoring systems.


RESULTS
Concomitant abdominal trauma, high Injury Severity Score (ISS), low International Classification of Diseases 9(th) revision Injury Severity Score (ICISS), and low probability of survival (Ps) were predictors for operative management. Compared to NOM-patients (66%, N=36), OP-patients (34%, N=19) suffered more frequently concomitant abdominal injuries (84.2% vs 47.2%, P=0.004) and were more severely totally injured as expressed by higher ISS (25 vs 20, P=0.01), lower ICISS (0.51 vs 0.74, P=0.003), and lower Ps (0.81 vs 0.98, P=0.005). NOM resulted in lower intensive care unit admission and mortality rates (47.2% vs 78.9%, P=0.002 and 2.7% vs 15.8%, P=0.03, respectively). NOM-success rate was 92%.


CONCLUSIONS
NOM of blunt hepatic trauma is safe and efficient. Concomitant abdominal trauma, ISS, ICISS, and Ps are predictors for operative or nonoperative management.
Markogiannakis
H
H
Department of Surgical Oncology, Herakleion University Hospital, Herakleion Medical School, University of Crete Herakleion, Crete, Greece. markogiannakis@yahoo.com
Sanidas
E
E
Michalakis
I
I
Manouras
A
A
Melissas
J
J
Tsiftsis
D
D
D000007:Abdominal Injuries / Q000175:diagnosis; D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D038801:International Classification of Diseases; D008099:Liver / Q000293:injuries*; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis; D018579:Patient Selection; D011379:Prognosis; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*