Hepatic trauma: effects of delay in presentation

Abstract

Objective: Hepatic trauma carries a substantial amount of morbidity & mortality. Purpose of study: The purpose of the study is to study the effects of delay in initiation of management of patients suffering from hepatic trauma. Design: Prospective study. Place & duration: The study was carried out in the Department of Surgery, Mayo Hospital Lahore from the year 1995-1997. Patient & methods: 57 patients were included in this study. They were operated and different methods of repair were employed. Results: 57 patients were studied. 50 were males, 7 were females. They belonged to an age range of 12-62 years. 55.7% patients suffered from blunt trauma while the rest of the cases were of penetrating injury. Over 50% of the patients presented within 4 hours of injury. All of the patients were operated and there findings noted. Different types of haemostatic measure were employed. There were ten mortalities in this study. Conclusions: Early presentation to the hospital of hepatic trauma cases, has a good impact o n the ultimate outcome of the patients.

The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review

“…Title and abstract screening excluded 1,889 records, and 66 full texts were evaluated. Twenty-four studies including 10,168 patients met the full eligibility criteria 9,16–38 . Reasons for exclusion included different patient population (n = 19), wrong exposure (n = 18), wrong study design (n = 4), and abstract without necessary data (n = 1).…”

“…Other proposed definitions of delay included 90 minutes from ED arrival to surgery for injuries to the aorta and inferior vena cava 16 and 3 to 4 hours from injury to hospital arrival for liver injuries requiring surgery. 35 Time cutoffs appeared to be selected after initial review of the data rather than a priori, where this information was provided. Remick and colleagues 18 analyzed time to mortality for patients who died from penetrating injuries within 4 hours, from which they concluded that delays of 43 minutes from injury to surgery would result in 50% mortality, while reducing this time to 19 minutes would potentially salvage 95% of patients.…”

“…9, The two largest studies contributed 56.2% (5,716 of 10,168) of the included patients, 18,25 and 15 of 24 studies contained more than 100 patients. One study was a prospective observational cohort, 35 one included analysis of prospectively collected randomized controlled trial data, 27 and the remainder was retrospective observational cohort studies. Fifteen studies took place in a single center, and nine were multicenter studies.…”

“…2). Nine studies (40.9%) were at very high risk of bias because of lack of control of confounding, 16,19,22,28,32,[34][35][36][37] and, for Rosengart et al, 32 very high risk of bias due to missing data. An additional nine studies (40.9%) were at high risk of bias, as important confounders were not controlled for despite control of other confounders.…”

“…For example, patients presenting within 2 hours required a mean of 1 to 3 bags, compared with greater than 12 bags for those presenting between 8 and 10 hours. 35 The authors did not perform any additional statistical analysis to quantify the impact of time on transfusion needs.…”