Eleven Years of Liver Trauma: The Scottish Experience

Abstract

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.

Trauma hepático: uma experiência de 21 anos

“…Regarding the AAST-OIS hepatic trauma classification, this study observed a predominance of grades I, II and III injuries. Literature demonstrates a predominance of lower complexity lesions (grades I, II and III), with a proportion of 73% in a study of 154 patients with hepatic trauma and 84% in a study of 783 such patients 10,14 . Major hepatic trauma (grades IV and V) is an uncommon event, even in trauma centers with high volumes of patients.…”

“…The decrease in incidence of penetrating trauma in Brazil can be explained by an improvement in the political control of urban violence in some regions, and the relative prevalence of blunt trauma is associated with an increased number of motor vehicles and motorcycles circulating in the country in recent decades, with a higher incidence of traffic victims 28 . Mortality from liver trauma ranges from 9 to 42%, and in most studies is close to 20% when considering all cases admitted to hospital 2,4,5,10,11,14,18,20 . In this study the mortality rate of 19.9% is in accordance with the literature.…”

“…This is in concordance with other published studies, and with the paradigm that men are often more exposed to traumatic injuries 2,10,11 . The young population is most affected, with an average age of 29.4 years, following the worldwide averages of 35, 32, 31 and 30 respectively in Germany, South Africa, Scotland and the USA [12][13][14][15] . Blunt and penetrating injuries vary according to the studied geographic region.…”

“…Blunt and penetrating injuries vary according to the studied geographic region. Studies performed in high income countries such as Scotland and Sweden demonstrated incidences of 69% and 91% of BHT, respectively 1,14 . Low income countries demonstrate a higher incidence of penetrating trauma; 66% in South Africa and 61.6% in our study, performed in Brazil 13 .…”

Trauma hepático: prevalência e características epidemiológicas de vítimas encaminhadas ao Instituto Médico Legal de Palmas, Tocantins

“…Estudos realizados na Europa geralmente mostram índices de trauma contuso superiores aos índices de trauma penetrante, enquanto que estudos em países em desenvolvimento observam o contrário [2,3]. Um levantamento populacional de todos os casos de trauma hepático identificados na Escócia entre 1992 e 2002, em que foram avaliados 783 casos, mostrou que o trauma contuso ocorreu em 69%, sendo a maioria deles por acidentes rodoviários [11]. Outros estudos europeus reafirmam a predominância do trauma contuso e, encontram índices maiores que 90% tanto em Estocolmo, na Suécia, quanto no Reino Unido [12][13][14].…”