The aim of this population based study was to assess the incidence, mechanisms, management, and outcome of patients who sustained hepatic trauma in Scotland (population 5 million) over the period 1992-2002. The Scottish Trauma Audit Group database was searched for details of any patient with liver trauma. Data on identified patients were analyzed for demographic information, mechanisms of injury, associated injuries, hemodynamic stability on presentation, management, and outcome. A total of 783 patients were identified as having sustained liver trauma. The male-to-female ratio was 3:1 with a median age of 31 years. Blunt trauma (especially road traffic accidents) accounted for 69% of injuries. Liver trauma was associated with injuries to the chest, head, and abdominal injuries other than liver injury; most commonly spleen and kidneys. In all, 166 patients died in the emergency department, and a further 164 died in hospital. The mortality rate was higher in patients with increasing age (p < 0.001), hemodynamic instability (p < 0.001), blunt trauma (p < 0.001), and increasing severity of liver injury (p < 0.001). The incidence of liver trauma in Scotland is low, but it accounts for significant mortality. Associated injuries were common. Outcome was worse in patients with advanced age, blunt trauma, multiple injuries and those requiring an immediate laparotomy.

Objective To determine whether the management of head injuries differs between patients aged >65 years and those < 65. Design Prospective observational national study over four years. Setting 25 Scottish hospitals that admit trauma patients. Participants 527 trauma patients with extradural or acute subdural haematomas. Main outcome measures Time to cranial computed tomography in the first hospital attended, rates of transfer to neurosurgical care, rates of neurosurgical intervention, length of time to operation, and mortality in inpatients in the three months after admission. Results Patients aged >65 years had lower survival rates than patients < 65 years. Rates were 15/18 (83%) v 165/167 (99%) for extradural haematoma (P=0.007) and 61/93 (66%) v 229/249 (92%) for acute subdural haematoma (P < 0.001). Older patients were less likely to be transferred to specialist neurosurgical care (10 (56%) v 142 (85%) for extradural haematoma (P=0.005) and 56 (60%) v 192 (77%) for subdural haematoma (P=0.004)). There was no significant difference between age groups in the incidence of neurosurgical interventions in patients who were transferred. Logistic regression analysis showed that age had a significant independent effect on transfer and on survival. Older patients had higher rates of coexisting medical conditions than younger patients, but when severity of injury, initial physiological status at presentation, or previous health were controlled for in a log linear analysis, transfer rates were still lower in older patients than in younger patients (P < 0.001). Conclusions Compared with those aged under 65 years, people aged 65 and over have a worse prognosis after head injury complicated by intracranial haematoma. The decision to transfer such patients to neurosurgical care seems to be biased against older patients.

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Aims: Clinically and intuitively, it is believed that the incidence of abdominal injuries is high when there is a combination of both thoracic and pelvic trauma. The aim of this study was to establish the true incidence of intra-abdominal injury in these patients. Methods: A retrospective analysis of the Scottish Trauma Audit Group (STAG) database for the 5-year period from 1997 to 2001 inclusive. Significant chest, abdominal and pelvic injuries were all defined as AIS 2. The incidence of abdominal trauma was calculated for different combinations of severity of chest and/or pelvic trauma. Results: 507/3644 (14%) patients with significant chest trauma but no pelvic trauma had concomitant abdominal injuries, compared to 111/1397 (8%) patients with pelvic trauma but no chest trauma. The likelihood of concomitant abdominal injury increased significantly if both chest and pelvis injuries were present (239/507, 47%; p < 0.001).Amongst patients with combined chest and pelvic trauma, the incidence of abdominal injury increased with severity of pelvic and chest injury (pelvis and chest both AIS = 2: 5/45, 11%; either pelvis or chest AIS = 3+: 81/198, 41%; both pelvis and chest AIS = 3+: 153/264, 58%; p < 0.001). For patients with chest but no pelvic trauma, intraabdominal injury was significantly more common amongst penetrating than blunt trauma (143/674, 21% versus 364/2970, 12%, p < 0.001). Conclusion: As expected, patients with serious chest and pelvic trauma have a much higher incidence of significant abdominal injury than patients with chest or pelvic trauma in isolation. Where laparotomy is not immediately indicated, imaging should be considered mandatory. #