title: Efficacy and safety of non-operative management of blunt liver trauma.
abstract: BACKGROUND
  The liver is the most frequently affected organ during blunt abdominal trauma. Blunt liver trauma management has changed in the last two decades with the introduction of the computed tomography (CT) scan and non-operative management of stable patients.
  
  
  OBJECTIVE
  To determine the incidence, efficacy, and failure rate of blunt liver trauma non-operative management as well as the risk factors associated with such treatment in a level 1 trauma center in Colombia.
  
  
  METHODS
  We conducted an observational descriptive study on patients with blunt liver trauma who were admitted to a level 1 trauma center in Colombia. The evaluated outcomes were indications of immediate surgical treatment and the success of non-operative management.
  
  
  RESULTS
  A total of 73 patients were studied. The most common mechanism of trauma continues to be motor vehicle crashes. In 14 patients (19.2%), immediate surgical intervention was necessary and we observed a Revised Trauma Score (RTS) above 7.8 and intra-abdominal injuries as risk factors. Three patients died (21.4%). Fifty-nine patients (80.8%) received non-operative management, which failed in seven patients (11.2%). Age, severity of liver injury, and intra-abdominal injuries were not risk factors in the failure of non-operative management. Mortality in the non-operative management group was 1.7%.
  
  
  CONCLUSIONS
  Non-operative management is the treatment of choice for polytraumatized patients with blunt liver trauma who are hemodynamically stable. Non-operative management is an effective and safe treatment strategy. However, patients with an RTS score under 7.8 and other intra-abdominal non-liver injuries are at increased risk for an immediate surgical intervention.
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia. cmorales@medicina.udea.edu.co.
authors.forename: C
authors.initials: C
authors.lastname: Morales
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: L
authors.initials: L
authors.lastname: Barrera
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Moreno
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Villegas
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: J
authors.initials: J
authors.lastname: Correa
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: L
authors.initials: L
authors.lastname: Sucerquia
authors.affiliation: Surgery Department, University of Antioquia, Hospital Universitario San Vicente de Paúl, Carrera 51D No. 62-29, 1226-229, Medellín, Antioquia, Colombia.
authors.forename: W
authors.initials: W
authors.lastname: Sanchez
keywords: Blunt trauma; Liver trauma; Non-operative management
references.citation: J Trauma. 1996 Jan;40(1):31-8
references.pmid: 8576995
references.citation: Ann Surg. 1995 Jun;221(6):744-53; discussion 753-5
references.pmid: 7794078
references.citation: J Am Coll Surg. 2006 Feb;202(2):212-5; quiz A45
references.pmid: 16427544
references.citation: Arch Surg. 2006 May;141(5):451-8; discussion 458-9
references.pmid: 16702516
references.citation: J Trauma. 2003 May;54(5):925-9
references.pmid: 12777905
references.citation: Arch Surg. 2004 Jul;139(7):800-1
references.pmid: 15249417
references.citation: Ann Surg. 1992 May;215(5):492-500; discussion 500-2
references.pmid: 1616386
references.citation: J Trauma. 2005 Mar;58(3):437-44; discussion 444-5
references.pmid: 15761334
references.citation: Surgeon. 2003 Apr;1(2):81-5
references.pmid: 15573625
references.citation: Ann Surg. 1986 Oct;204(4):438-45
references.pmid: 3767479
references.citation: Arch Surg. 2003 May;138(5):475-80; discussion 480-1
references.pmid: 12742948
references.citation: Am J Surg. 1992 Nov;164(5):477-81
references.pmid: 1443372
references.citation: Am Surg. 2005 May;71(5):379-86
references.pmid: 15986966
references.citation: Arch Surg. 2003 Aug;138(8):844-51
references.pmid: 12912742
references.citation: Curr Probl Surg. 2001 Jan;38(1):1-60
references.pmid: 11202160
references.citation: Br J Surg. 2009 Jan;96(1):104-10
references.pmid: 19109805
references.citation: Am Surg. 1998 Jun;64(6):552-6; discussion 556-7
references.pmid: 9619177
references.citation: Surgery. 2005 Oct;138(4):606-10; discussion 610-1
references.pmid: 16269288
references.citation: J Trauma. 2005 Nov;59(5):1175-8; discussion 1178-80
references.pmid: 16385297
references.citation: J Trauma. 1990 Sep;30(9):1096-101; discussion 1101-3
references.pmid: 2213943
references.citation: World J Surg. 2005 Jun;29(6):744-9
references.pmid: 15880277
references.citation: World J Surg. 2002 May;26(5):544-9; discussion 549
references.pmid: 12098042
references.citation: World J Surg. 2003 Oct;27(10 ):1124-30
references.pmid: 12917767
references.citation: J Trauma. 2002 Aug;53(2):238-42; discussion 242-4
references.pmid: 12169928
references.citation: J Trauma. 2005 Nov;59(5):1066-71
references.pmid: 16385280
references.citation: Surg Clin North Am. 2004 Apr;84(2):437-50
references.pmid: 15062654
references.citation: Ann Surg. 2000 Jun;231(6):804-13
references.pmid: 10816623
references.citation: J Am Coll Surg. 2008 Nov;207(5):646-55
references.pmid: 18954775
references.citation: Ann Surg. 2000 Sep;232(3):324-30
references.pmid: 10973382