Six of the Best, General 22

Aims: To show that most liver trauma can be managed conservatively and that early abdominal CT reduces the frequency of operative treatment in nonspecialized centres which carries a high mortality. Methods: We retrospectively analysed data from 52 consecutive patients referred to the Queen Elizabeth Hospital, Birmingham over a 10-year period to identify best practice in the management of these injuries. Results: The majority of injuries occurred as a result of road traffic accidents. Seventy-five per cent of the patients were stable at presentation to the referring hospital. In 70 per cent of the patients, the liver injury was a component of multiple trauma. USS, CT and no radiological investigation were used in the referring hospital in 35, 48 and 17 per cent, respectively. Operative management was undertaken in the referring hospital in 50 per cent of patients. The overall mortality in the series was 21 per cent and increased with increasing grade of severity. The mortality in patients managed operatively at the referring hospital was 31 per cent and in those managed conservatively was 15 per cent (P = ns). The median time from arrival to surgery in the referring hospital was 4 h in haemodynamically stable patients and 3 h in haemodynamically unstable patients. Conclusion: Our data suggests that the majority of cases of liver trauma may be managed conservatively and that operative management in nonspecialized units carries high mortality and morbidity. Abdominal injuries should raise a high index of suspicion of liver injury, and abdominal CT should precede laparotomy (even in some haemodynamically unstable patients) to facilitate early discussion with a specialist centre.