Korean J Crit Care Med.  2014 Nov;29(4):320-327. 10.4266/kjccm.2014.29.4.320.

Traumatic Liver Injury: Factors Associated with Mortality

Affiliations
  • 1Department of Emergency Medicine, Konyang University Hospital, Daejeon, Korea. neokey@naver.com

Abstract

BACKGROUND
We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients.
METHODS
From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study.
RESULTS
Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006).
CONCLUSIONS
In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.

Keyword

embolization, therapeutic; intervention; liver injury; time factors

MeSH Terms

Coma
Embolization, Therapeutic
Emergency Service, Hospital
Humans
Incidence
Liver*
Mortality*
Odds Ratio
Patient Admission
Prognosis
Retrospective Studies
Time Factors

Reference

References

1). Søreide K. Epidemiology of major trauma. Br J Surg. 2009; 96:697–8.
Article
2). Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002; 52:420–5.
Article
3). Park WD, Kim BY, Choi WJ. Traumatic liver injury. Korean J Crit Care Med. 1990; 5:67–74.
4). Beardsley C, Gananadha S. An overview of liver trauma. MSJA. 2011; 3:5–10.
5). Cha SH, Jung YS, Won JH, Kim WW, Wang HJ, Kim MW, et al. Use of a postoperative hepatic arterial embolization in patients with postoperative bleeding due to severe hepatic injuries. J Korean Soc Traumatol. 2006; 19:59–66.
6). Chien LC, Lo SS, Yeh SY. Incidence of liver trauma and relative risk factors for mortality: a population-based study. J Chin Med Assoc. 2013; 76:576–82.
Article
7). Kim SC, Cho MS, Bae KS, Kim YJ. The validity of hepatic arterial embolization in management of traumatic liver injury. J Korean Soc Traumatol. 2004; 17:131–38.
8). Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000; 231:804–13.
Article
9). Yoon HM, Yoon YS, Shin SH, Cho JY, Park DJ, Kim HH, et al. Clinical analysis on patients with traumatic liver injury. J Korean Soc Traumatol. 2007; 20:125–29.
10). Olthof DC, Sierink JC, van Delden OM, Luitse JS, Goslings JC. Time to intervention in patients with splenic injury in a Dutch level 1 trauma centre. Injury. 2014; 45:95–100.
Article
11). Cogbill TH, Moore EE, Jurkovich GJ, Feliciano DV, Morris JA, Mucha P. Severe hepatic trauma: a multi-center experience with 1,335 liver injuries. J Trauma. 1988; 28:1433–8.
12). Feliciano DV, Mattox KL, Jordan GL Jr, Burch JM, Bitondo CG, Cruse PA. Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann Surg. 1986; 204:438–45.
Article
13). Holden A. Abdomen--interventions for solid organ injury. Injury. 2008; 39:1275–89.
Article
14). Demetriades D, Kuncir E, Murray J, Velmahos GC, Rhee P, Chan L. Mortality prediction of head abbreviated injury score and glasgow coma scale: analysis of 7,764 head injuries. J Am Coll Surg. 2004; 199:216–22.
15). Sternbach GL. The Glasgow coma scale. J Emerg Med. 2000; 19:67–71.
Article
16). Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead head injury project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993; 7:267–79.
Article
17). Lee WC, Kuo LC, Cheng YC, Chen CW, Lin YK, Lin TY, et al. Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration. Am J Emerg Med. 2010; 28:1024–9.
Article
18). Howell GM, Peitzman AB, Nirula R, Rosengart MR, Alarcon LH, Billiar TR, et al. Delay to therapeutic interventional radiology postinjury: time is of the essence. J Trauma. 2010; 68:1296–300.
Article
19). Bernardo CG, Fuster J, Bombuy E, Sanchez S, Ferrer J, Loera MA, et al. Treatment of liver trauma: operative or conservative management. Gastroenterology Research. 2010; 3:9–18.
Article
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