Management of blunt liver injury safety profile of the nonoperative management

Abstract

Background. Multiple studies support the nonoperative management (NOM) of blunt liver injury (BLI). Hemodynamically unstable patients remain a clear-cut indication for operative management. This study elucidates the failure rate of NOM as well as the etiology of unsuccessful NOM. Methods. A retrospective chart review of 538 trauma admissions with documented BLI was conducted at a level I trauma center. BLI was classified according to the AAST Organ Injury Scale. Variables included were age, grade of the liver injury, associated organ injuries, injury severity scale, transfusion requirement, and the need for exploratory laparotomy. Laparotomy was defined as delayed when patient needed operation after departure from the emergency department. Delayed exploratory laparotomy was considered a failure of NOM when surgery was performed to control liver hemorrhage. Results. Mean age was 35 years; 55% were men. Mean BLI grade was 2.4 and ISS was 23. Thirty-six percent had other associated intraabdominal injury. Of the 538 patients, only 102 (19%) went to operation and 20 were delayed. Of these, 18 patients had other injuries as primary cause for exploration (spleen, hollow viscus, abdominal compartment syndrome, etc.). Only two patients (0.005%) failed NOM; both had Grade V injury and both required surgery within 4 h from admission. Conclusion. The success rate of NOM in the stable patient with BLI is nearly 100%. Heightened care should be emphasized on patients with other intraabdominal injury or large fluid resuscitation who may fail NOM.