title: Management of grade III-IV blunt liver traumas: a comparative, observational study.
abstract: OBJECTIVE
  The aim of the present study was to assess the impact of angiographic embolization in view of expanding indications for the conservative management of grade III-IV liver injuries.
  
  
  METHODS
  Fifty adult patients with grade III-IV hepatic trauma were admitted to our Hepato-Biliary-Pancreatic Surgery and Level II Regional Trauma Center from 1993 to 2010 and retrospectively analyzed. Injury severity, management strategies and outcomes of patients admitted between 1993 and 2005 were analyzed and compared with those admitted between 2005 and 2010. Univariable and multivariable logistic models were fitted to investigate the differences between the two time windows studied, in particular with regard to morbidity, mortality, treatment and outcomes, the use of non-operative management and of angiographic embolization.
  
  
  RESULTS
  At univariable analysis the majority of the patients treated after 2005 were more likely to have undergone arterial embolization, and less likely to have incurred morbidity, conversion to surgery, or to be admitted to the Intensive Care Unit after initial treatment (baseline category). At multivariable analysis the patients treated before 2005 were more likely to be older than 25 years to receive angiographic embolization and less likely to undergo conversion to surgery after failure of non-operative management.
  
  
  CONCLUSIONS
  The criteria for the conservative treatment of blunt liver trauma is presently often based on hemodynamic stability in injured patients, but its successful management should, instead, be based also on early CT recognition of arterial bleeding and prompt use of angiographic embolization to control it.
authors.affiliation: II Department of Surgery (IV Unit) Regional Hospital "Ca' Foncello", Treviso, Italy - bonariol@libero.it.
authors.forename: L
authors.initials: L
authors.lastname: Bonariol
authors.forename: M
authors.initials: M
authors.lastname: Massani
authors.forename: E
authors.initials: E
authors.lastname: Caratozzolo
authors.forename: C
authors.initials: C
authors.lastname: Ruffolo
authors.forename: A
authors.initials: A
authors.lastname: Recordare
authors.forename: M
authors.initials: M
authors.lastname: Scarpa
authors.forename: T
authors.initials: T
authors.lastname: Stecca
authors.forename: L
authors.initials: L
authors.lastname: Cegolon
authors.forename: N
authors.initials: N
authors.lastname: Bassi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*