title: The role of computed tomography in determining delayed intervention for gunshot wounds through the liver.
abstract: BACKGROUND
  Gunshot wounds through the liver are highly lethal and are prone to delayed morbidity due to late complications.
  
  
  METHODS
  A retrospective study was performed to determine the incidence, morbidity, and need for late interventions in patients shot through the liver, and the role of post-injury CT in making those determinations.
  
  
  RESULTS
  83 patients were shot through the liver. Injury grades were: Grade V-12 (14 %), Grade IV-41 (49 %), Grade III-12 (14 %), Grade II-8 (10 %), Grade I-1 (1 %), and nine were ungraded. Ten (12 %) died in the ED, three (4 %) died in the OR, and two (2 %) died postoperatively. Of the 68 survivors, 52 (76 %) had follow-up CT scans performed a median of 7 days (95 % CI 2-13 days) after injury. Seventeen (33 %) had 25 complications related to the bullet tract: 12 (48 %) abscesses, 6 (24 %) infected hematomas, 3 (12 %) bilomas, 3 (12 %) unclassified fluid collections, and 1 (4 %) hepatic necrosis. Treatment included CT-guided drainage in 15 (60 %), ultrasound-guided drainage in 3 (12 %), surgical drainage and debridement in 2 (8 %), and observation in 5 (20 %). Overall morbidity rate including hepatic and non-hepatic complications was 74 % (50/68). Patients having their CT scan-determined intervention (for all complications) within 7 days of injury (n = 24), compared to those having their CT scan-determined intervention on day 8 or later (n = 28), had a significantly decreased rate of overall complications and morbidity (p = 0.03). This difference was due to early detection and intervention for abscesses, anastomotic breakdown, and missed injuries. Those having a CT scan within 7 days of injury also had a significantly reduced length of stay compared to those scanned on day 8 or later (median 14 days, 95 % CI 4-24 days versus 18 days, 95 % CI 6-30 days, p = 0.05).
  
  
  CONCLUSIONS
  Gunshot wounds to the liver have a high morbidity and mortality rate. Survivors should have a follow-up CT scan performed within 7 days to allow detection and intervention for complications, as this dramatically decreases the overall morbidity rate and length of stay.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA.
authors.forename: G
authors.initials: G
authors.lastname: Sachwani-Daswani
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dombrowski
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Shetty
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Hurley Medical Center, One Hurley Plaza, Flint, MI, 48503, USA. heartandbones@yahoo.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Carr
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery
keywords: CT scan; Hepatic; Injury; Liver; Outcome; Trauma