title: Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre.
abstract: BACKGROUND
  Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period.
  
  
  METHODS
  Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records.
  
  
  RESULTS
  A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury.
  
  
  CONCLUSIONS
  This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent.
  
  
  CONCLUSIONS
  NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.
authors.affiliation: Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway. t-koyama@office.nifty.jp.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
authors.forename: Jorunn
authors.initials: J
authors.lastname: Skattum
authors.affiliation: School of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Peder
authors.initials: P
authors.lastname: Engelsen
authors.affiliation: Department of Anesthesiology, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Torsten
authors.initials: T
authors.lastname: Eken
authors.affiliation: Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.affiliation: Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424, Oslo, Norway.|University of Oslo, Oslo, Norway.
authors.forename: Pål Aksel
authors.initials: PA
authors.lastname: Naess
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods*; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D009104:Multiple Trauma; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000601:surgery*
keywords: Angiographic embolization; Children; Hepatic trauma; Nonoperative management; Traumatic bile leak