Liver Trauma in Plymouth, UK : Epidemiological analysis of clinical pattern and mechanism of injury

Abstract

Background: Liver trauma is the second most common cause of mortality and morbidity trauma patients. Liver trauma often managed conservatively, but the underlying mechanism of injury and associated injuries often dictate the need for surgery. Understanding of the mechanism of injury is important to take appropriate preventative measures. Aim of this study is to analyse the management of liver trauma patients in a major trauma centre. Conclusions: Retrospective study of all patients with liver trauma presented to University Hospitals Plymouth NHS Trust between July 2004 and April 2015. Data were obtained from patient clinical notes and trauma data base: demographics, mechanism and type injuries, management and follow up details. Results: In the study period, 112 patients were managed for liver trauma with or without other injuries. Majority of patients were male (69 patients ,62%), with median age of 35 (range: 1-90) years. In 90 patients (81% ) the underlying cause of liver injury was due to Blunt Trauma (BT) Overall, 54% of all the liver trauma happened over the weekend. At the time of presentation, 78 patients (70 %) were haemodynamically stable. 109 patients had Trauma CT-scan in Emergency Department. 3 patients went directly to theatre due to hemodynamic instability,. After non-operative management, only 4 patients (4.1%) required direct laparotomy due to instability. 6 (5.3%) patients were managed with Interventional Radiology embolization. 18 patients (16%) had emergency laparotomy requiring packing (9 patients) ,suture hemostasis (6) or washout (3). Cumulative complications rate was 60%. Median length of hospital stay in the hospital was 18 days (0-186). Mortality was 9% (7 patients post-laparotomy, 2 patients after non-operative management) Conclusion: There is a peculiar pattern of prevalence of type of injury and demographics of patients presenting with Liver Trauma in Devon, the majority of which can be successfully managed with non-operative approach.