The Evolving Management of Blunt Hepatic Trauma in a Rural Setting

Abstract

Over the past decade, a nonoperative approach toward the management of blunt hepatic trauma has become prevalent at most major urban trauma centers. To determine the applicability of the nonoperative approach in a rural setting, a 10-year retrospective review was conducted at a level I rural university-based trauma center. The Census Bureau defines ruralized areas to provide a better separation of urban and rural territory and population. A ruralized area is composed of one or more places and the adjacent surrounding territory that together have a maximum of 50,000 persons. West Virginia University is classified as a rural academic medical center and is situated in Morgantown, whose permanent population does not exceed 35,000. All patients with documented blunt hepatic trauma between July 1990 and June 2000 were identified and reviewed. To evaluate evolving trends, the patients were divided into two groups: group A (July 1, 1990-June 30, 1995) and group B (July 1, 1995-June 30, 2000). There were 236 patients with documented blunt hepatic trauma identified between July 1, 1990, and June 30, 2000). Overall, 70 per cent of patients were managed conservatively. When comparing the two groups, statistical significance was obtained in mean hospital length of stay (LOS) [19.8 days A vs. 9.1 days B (P < 0.0001)]; mean intensive care unit (ICU) days [15.2 days A vs. 5.3 days B (P < 0.0001)], blood transfusion [10 units A vs. 4.2 units B (P < 0.0016)], number of patients requiring surgery [52 (46%) A vs. 37 (30%) B (P < 0.022)]. There was only one death associated with nonoperative management. We have shown a definite trend toward nonoperative management of blunt hepatic trauma in a rural setting over the past decade. More than 70 per cent of our liver injury patients over the past 5 years have been managed nonoperatively, with statistically significant reductions in hospital LOS, ICU LOS, and transfusion requirements. We have found a definite trend over the past decade toward nonoperative management of blunt hepatic trauma in a rural setting. The rural setting with a delay in transport time to level I trauma center also did not significantly affect the outcome of the patients with nonoperative management of liver injuries. Approximately 78 per cent of our liver injury patients over the past 5 years have been managed nonoperatively and are associated with statistically significant reductions in hospital and ICU LOS and transfusion requirements.