title: Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre.
abstract: OBJECTIVE
  Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. We aimed to assess prognostic factors for morbidity and mortality in patients with severe liver trauma undergoing perihepatic packing.
  
  
  METHODS
  Prospectively collected records of 293 consecutive polytrauma patients with liver injury admitted at a level I trauma centre between 1996 and 2008 were reviewed. 39 patients with grade IV-V AAST liver injury and treated with peri-hepatic packing were identified and included for analysis. Univariate and multivariate analyses were performed to assess prognostic factors for morbidity and mortality.
  
  
  RESULTS
  Mean age of patients was 41 years. 34 patients were haemodynamically unstable at initial presentation. Ten of 39 patients were treated with angiographic embolization in addition to perihepatic packing. The overall mortality rate was 51.3%. Liver-related death occurred in 23.1%. Overall and liver-related morbidity rates were 90% and 28%, respectively. Glasgow Coma Scale (GCS), respiratory rate, packed red blood cells (PRBC) transfusion, pH and Base Excess (BE), Revised Trauma Score (RTS) and Trauma Injury Severity Score (TRISS), need for angiographic embolization as well as early OR and ICU admission were associated with significant decrease of early mortality.
  
  
  CONCLUSIONS
  Revised Trauma Score, haemodynamic instability, blood pH and BE are important prognostic factors influencing morbidity and mortality in polytrauma patients with grade IV/V liver injury. Furthermore, fast and effective surgical damage control procedure with perihepatic packing, followed by early ICU admission is associated with lower complication rate and shorter ICU stays in this patient population.
authors.affiliation: Department of Emergency, Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital, Bologna Local Health District, Bologna, Italy. salo75@inwind.it
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Filippo
authors.initials: F
authors.lastname: Filicori
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Xavier M
authors.initials: XM
authors.lastname: Keutgen
authors.forename: Aimone
authors.initials: A
authors.lastname: Giugni
authors.forename: Carlo
authors.initials: C
authors.lastname: Coniglio
authors.forename: Andrea
authors.initials: A
authors.lastname: Biscardi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Cavallo
authors.forename: Francesca
authors.initials: F
authors.lastname: Mengoli
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Cinquantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000792:Angiography; D001803:Blood Transfusion; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000293:injuries* / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome