Management of liver injuries: Predictors for the need of operation and damage control surgery
| Autor: | Rattaplee Pak-art, Pasurachate Samorn, Supparerk Prichayudh, Chayatat Sirinawin, Suvit Sriussadaporn, Kritaya Kritayakirana, Sukanya Sriussadaporn |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Tachycardia medicine.medical_specialty medicine.medical_treatment Peritonitis Wounds Penetrating Wounds Nonpenetrating Injury Severity Score Trauma Centers Risk Factors Laparotomy medicine Humans Hospital Mortality Retrospective Studies General Environmental Science Liver injury medicine.diagnostic_test business.industry Mortality rate Angiography Emergency department Thailand medicine.disease Embolization Therapeutic Surgery Treatment Outcome Liver Damage control surgery General Earth and Planetary Sciences Female Hypotension medicine.symptom business |
| Zdroj: | Injury. 45:1373-1377 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2014.02.013 |
| Popis: | Management of liver injuries: Predictors for the need of operation and damage control surgery,The advancement in the management of liver injuries, including the use of non-operative management (NOM), damage control surgery (DCS) and angiographic embolisation (AE); has resulted, in improvement of outcomes. The aim of this study is to analyse the outcome of liver injury patients in our institution and to identify predictors for the need of operative management (OM) and DCS.We retrospectively reviewed 218 patients with liver injury admitted to King, Chulalongkorn Memorial Hospital from May 2002 to May 2011. Data collection included demographic, data, emergency department parameters, detail of liver injuries, and outcome in terms of mortality rate (MR). Stepwise logistic regression was performed to identify mutually independent predictors for the need of OM and DCS.Two hundred and eighteen patients with liver injury were identified (156 blunt and 62 penetrating). One hundred fifty-four patients (70.6%) underwent OM due to hemodynamic instability, (96), peritonitis (24), and other indications (34). DCS (perihepatic packing and temporary abdominal, closure) was utilised in 45 patients. NOM was attempted in 64 patients (29.4%), 6 of these, subsequently required laparotomy (success rate 90.6%). Angiography was performed in 47 patients, (14 in NOM, 33 in OM) and 40 patients received AE (10 in NOM, 30 in OM). Overall MR was 17.4%, the, MR was significantly higher in OM than in NOM (24 vs. 1.6%; p0.001, OR 19.92). The mutually independent predictors for the need of operation were low Glasgow Coma Score (GCS), penetrating mechanism, tachycardia, and hypotension; while the independent predictors for DCS were high grade (4) liver injury, tachycardia, and blunt mechanism.Overall MR of liver injury patients was 17.4%. NOM carried a low MR and should be, attempted in the absence of hemodynamic instability and peritonitis. Patients with low GCS, penetrating injury, tachycardia, and hypotension were more likely to require operation. DCS should be considered while operating on patients with high grade liver injury, tachycardia, and blunt mechanism. |
| Databáze: | OpenAIRE |
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