Objective:

The aim of the study was to analyze retrospectively the factors affecting the mortality rate in patients with hepatic trauma who were treated operatively.

Material and Methods:

Parameters analyzed were demographics, presence of shock, type of injury, grade of injury, Injury Severity Score (ISS) and abdominal trauma index (ATI), number of injured abdominal organs (NIAO), operative procedures, length of hospital stay and mortality. Indications for operation were hemodynamically instability after rapid initial resuscitation, suspected concomitant abdominal organ injury, signs of peritoneal irritation, and need for more than two units of blood transfusion. Liver and other organ injuries were graded according to Abbreviated Injury Scale (AIS) 1990 revision (AIS-90). ISS and ATI scores were calculated for each patient.

Results:

Mean age was 25±8 years. Six patients had blunt and 11 had penetrating trauma. Grade III or more severe hepatic injuries consisted 64.6%. The grade of liver injury correlated significantly with length of hospital stay (r:0.65, p=0.015). A total of eleven patients suffered from shock at first presentation. Concomitant intra- or extra-abdominal organ injury was detected in 13 patients (76.5%). NIAO in patients who survived and who died were 1.8±0.9 and 2.3±0.8, respectively (p0.05). Forty percent of patients with NIAO ³3 and 16.6% of patients with NIAO <3 died. Operative procedures for liver injury were hepatorraphy (n:8), peri-hepatic packing (n:4) and right lobectomy (n:1). The overall mortality rate was %23.5. Mean hospital stay was 11 days. In patients with blunt trauma, there was a trend towards higher mortality (mortality rate was 3/6 in blunt trauma and 1/5 in penetrating trauma OR:10, p=0.05). Blunt trauma significantly correlated with grade of liver injury (r:0.74, p=0.001) and number of blood transfusions (r:0.75, p=0.002). Grade of liver injury also significantly correlated with number of blood transfusions (r: 0.66, p=0.01). Presence of shock correlated significantly with hematocrit level (r:0.80, p=0.001), grade of liver injury (r:0.50, p=0.03), and number of blood transfusions (r:0.60, p=0.006). Mean ISS in patients who died and survived were 32.5 and 12.4, respectively (p=0.0001), and mean ATI in patients who died and survived were 39.2 and 15.3, respectively (p=0.001). Correlation analysis demonstrated that both ISS and ATI correlated significantly with mortality (r:0.74, p=0.0001 for ISS and r:0.60, p=0.001 for ATI). ISS and ATI also correlated significantly with each other (r:0.83, p=0.0001).

Conclusion:

Grade of liver injury, ISS and ATI were found to have a significant effect on mortality in this study. Applicability and prognostic effects of both ISS and ATI in blunt and penetrating abdominal trauma are validated in this relatively small group of trauma patients as they were found to be correlated with each other and mortality. Therefore they still stand as appropriate score systems to determine prognosis.

Keywords: Liver, trauma, trauma scoring systems, ISS, ATI