title: Management and outcome of 308 cases of liver trauma in Bologna Trauma Center in 10 years.
abstract: BACKGROUND
  Management of Liver Trauma may vary widely from NOM +/- angioembolization to Damage Control Surgery. Multidisciplinary management is essential for achieving better outcomes.
  
  
  METHODS
  During 2000-2009 period 308 patients with liver injury were admitted to level 1 trauma center and recorded in Trauma Registry. Collected data are demographics, AAST grade, initial treatment (operative or non-operative treatment) and outcome (failure of NOM), death. All patients were initially assessed according to ATLS guidelines. In case of haemodynamic instability and FAST evidence of intra-abdominal free fluid, the patients underwent immediate laparotomy. Hemodynamically stable patients, underwent CT scan and were admitted in ICU for NOM.
  
  
  RESULTS
  Two hundred fourteen patients (69.5%) were initially managed with NOM. In 185 patients this was successful. Within the other 29 patients, failure of NOM was due to liver-related causes in 12 patients and non-liver-related causes in 17 Greater the grade of liver injury, fewer patients could be enrolled for NOM (85.8% in I-II and 83.3% in III against 39.8% in IV-V). Of those initially treated non-operatively, the likelihood of failure was greater in more severely injured patients (24.4% liver-related failure rate in IV-V against the 1.3% and 1.0% in I-II and III respectively). One hundred twenty-three patients (40% of the whole population study--308 patients) underwent laparotomy: 94 immediately after admission, because no eligible for NOM; 29 after NOM failure . In the 81 patients in which liver bleeding was still going on at laparotomy, hemostasis was attempted in two different ways: in the patients affected by hypothermia, coagulopathy and acidosis, perihepatic packing was the treatment of choice. In the other cases a "direct repair" technique was preferred. "Early mortality" which was expected to be worse in patients with such metabolic derangements, was surprisingly the same of the other group. This proves efficacy of the packing technique in interrupting the "vicious cicle" of hypothermia, coagulopathy and acidosis, therefore avoiding death ("early death" in particular) from uncontrollable bleeding.
  
  
  CONCLUSIONS
  NOM +/- angioembolization is safe and effective in any grade of liver injury provided hemodynamic stability. DCS is Gold Standard for hemodynamically unstable patients.
authors: Trauma Surgery Unit, Trauma Center (Head Dr. G. Tugnoli), Department of Emergency, Maggiore Hospital, Bologna, Italy.
authors: Nicola
authors: N
authors: Clemente
authors: Salomone
authors: S
authors: Di Saverio
authors: Eleonora
authors: E
authors: Giorgini
authors: Andrea
authors: A
authors: Biscardi
authors: Silvia
authors: S
authors: Villani
authors: Gianluca
authors: G
authors: Senatore
authors: Filippo
authors: F
authors: Filicori
authors: Nicola
authors: N
authors: Antonacci
authors: Franco
authors: F
authors: Baldoni
authors: Gregorio
authors: G
authors: Tugnoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000401:mortality; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007558:Italy; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery / Q000628:therapy*