title: Management of liver injuries: predictors for the need of operation and damage control surgery.
abstract: Management of liver injuries: Predictors for the need of operation and damage control surgery,
  
  
  BACKGROUND
  The advancement in the management of liver injuries, including the use of non-operative management (NOM), damage control surgery (DCS) and angiographic embolisation (AE); has resulted, in improvement of outcomes. The aim of this study is to analyse the outcome of liver injury patients in our institution and to identify predictors for the need of operative management (OM) and DCS.
  
  
  METHODS
  We retrospectively reviewed 218 patients with liver injury admitted to King, Chulalongkorn Memorial Hospital from May 2002 to May 2011. Data collection included demographic, data, emergency department parameters, detail of liver injuries, and outcome in terms of mortality rate (MR). Stepwise logistic regression was performed to identify mutually independent predictors for the need of OM and DCS.
  
  
  RESULTS
  Two hundred and eighteen patients with liver injury were identified (156 blunt and 62 penetrating). One hundred fifty-four patients (70.6%) underwent OM due to hemodynamic instability, (96), peritonitis (24), and other indications (34). DCS (perihepatic packing and temporary abdominal, closure) was utilised in 45 patients. NOM was attempted in 64 patients (29.4%), 6 of these, subsequently required laparotomy (success rate 90.6%). Angiography was performed in 47 patients, (14 in NOM, 33 in OM) and 40 patients received AE (10 in NOM, 30 in OM). Overall MR was 17.4%, the, MR was significantly higher in OM than in NOM (24 vs. 1.6%; p<0.001, OR 19.92). The mutually independent predictors for the need of operation were low Glasgow Coma Score (GCS), penetrating mechanism, tachycardia, and hypotension; while the independent predictors for DCS were high grade (>4) liver injury, tachycardia, and blunt mechanism.
  
  
  CONCLUSIONS
  Overall MR of liver injury patients was 17.4%. NOM carried a low MR and should be, attempted in the absence of hemodynamic instability and peritonitis. Patients with low GCS, penetrating injury, tachycardia, and hypotension were more likely to require operation. DCS should be considered while operating on patients with high grade liver injury, tachycardia, and blunt mechanism.
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand. Electronic address: Supparerk.P@Chula.ac.th.
authors.forename: Supparerk
authors.initials: S
authors.lastname: Prichayudh
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Chayatat
authors.initials: C
authors.lastname: Sirinawin
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Suvit
authors.initials: S
authors.lastname: Sriussadaporn
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Rattaplee
authors.initials: R
authors.lastname: Pak-art
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Kritaya
authors.initials: K
authors.lastname: Kritayakirana
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Pasurachate
authors.initials: P
authors.lastname: Samorn
authors.affiliation: Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
authors.forename: Sukanya
authors.initials: S
authors.lastname: Sriussadaporn
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000601:surgery; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D010538:Peritonitis / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013610:Tachycardia / Q000601:surgery; D013785:Thailand / Q000453:epidemiology; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*
keywords: Damage control surgery; Liver injury; Non-operative management