title: Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation.
abstract: BACKGROUND
  Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival.
  
  
  METHODS
  Patients sustaining hepatic trauma were identified using the Trauma Audit and Research Network database. Demographics, management and outcomes were assessed between January 2005 and December 2014 and analysed over five, 2-year study periods. Independent predictor variables for the outcome of liver trauma were analysed using multiple logistic regression.
  
  
  RESULTS
  4368 Patients sustained hepatic trauma (with known outcome) between January 2005 and December 2014. Median age was 34 years (interquartile range 23-49). 81% were due to blunt and 19% to penetrating trauma. Road traffic collisions were the main mechanism of injury (58.2%). 241 patients (5.5%) underwent liver-specific surgery. The overall 30-day mortality rate was 16.4%. Improvements were seen in early consultant input, frequency and timing of computed tomography (CT) scanning, use of tranexamic acid and 30-day mortality over the five time periods. Being treated in a unit with an on-site HPB service increased the odds of survival (odds ratio 3.5, 95% confidence intervals 2.7-4.5).
  
  
  CONCLUSIONS
  Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.
authors.affiliation: Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-2295-1259
authors.initials: J
authors.lastname: Barrie
authors.affiliation: Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jamdar
authors.affiliation: Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.
authors.forename: M F
authors.initials: MF
authors.lastname: Iniguez
authors.affiliation: Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.
authors.forename: O
authors.initials: O
authors.lastname: Bouamra
authors.affiliation: Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.
authors.forename: T
authors.initials: T
authors.lastname: Jenks
authors.affiliation: Trauma Audit and Research Network (TARN), Manchester Academic Health Science Centre, The University of Manchester, Manchester, M6 8HD, UK.|EMRiS Group, HSR Section, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: F
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Department of Hepato-pancreatobiliary Surgery, Manchester Royal Infirmary, Central Manchester Foundation Trust, Oxford Rd, Manchester, M13 9WL, UK. doreilly@doctors.org.uk.|School of Medical Sciences, The University of Manchester, Manchester, UK. doreilly@doctors.org.uk.
authors.forename: D A
authors.initials: DA
authors.lastname: O'Reilly
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000401:mortality; D004635:Emergency Medicine / Q000592:standards; D004739:England / Q000453:epidemiology; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008099:Liver / Q000293:injuries* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis; D014148:Tranexamic Acid / Q000627:therapeutic use; D014852:Wales / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Centralisation; Hepatobiliary; Liver; Outcomes; Trauma