The proper follow up time to CT scan and outcome of management in high grade traumatic liver injury

Abstract

Purpose: Liver is most frequently injured organ in blunt abdominal trauma. The American Association for the Surgery of Trauma (AAST) classifies liver injury severity into 5 grades but not fully indicated to operate or conservative treatment, according to many of liver injury high grade were successfully treat as non-operative management. Currently, there is no consensus proper time to follow up imaging on traumatic liver and exactly healing time depended on grading of the injury. This study aim to evaluate overall healing rate of traumatic liver injury at 4 weeks and identify healing factors of injured liver. Methods: Medical records reviewed all patients with traumatic liver injury in Bhumibol Adulyadej Hospital from January 1, 2014 to December 31, 2019. Initial patient data obtained included gender, age, hemodynamic stability, mechanism of injury, associated injury, liver injury grading, hemotocrit level, liver function test, operative management, length of ICU stay, and length of hospital stay. Follow up data at 4-week included healing of liver injury from interval CT scan and review by single radiologist. Patients were classified into high grade liver injury (grade IV-V) and low grade liver injury (Grade I-III) were analyzed the outcome. Results: 126 traumatic liver injury patients were included. Of these, 54 (43%) patients were high grade liver injury and 72 (57%) were low grade liver injury. There were 68 patients founded healing on CT scan at 4 weeks after injury 79.4% were blunt mechanism whereas 20.6% were penetrating injury compare to Non healing group of 58 patients were blunt mechanism 95.8% and penetrating trauma 5.2% (p 0.012). The 4th week scan also found healing liver all mechanism only 7.4% of high grade liver injury whiles healed liver up to 88.9% in low grade injury ( p <0.01) and healing factors were blunt mechanism, hematocrit above 30% on arrival with absent of associated injury, however length of hospital stay (12.97 vs 15.33, p <0.36) and ICU stay (3.13 vs 3.36, p <0.688) shown no statistical significant different. Non-operative management were success in healed liver group 82.4% but patient who fail conservative and need liver relate surgery were still found up to healed 67.2%. Conclusions: Low grade liver injury almost healed at 4 weeks after injury which enhancing factor are blunt mechanism without anemia on arrival and absent of associated injury. CT scan are still usefulness imaging to evaluation the liver trauma.