Changes in the management of liver trauma leading to reduced mortality: 15‐year experience in a major trauma centre
| العنوان: | Changes in the management of liver trauma leading to reduced mortality: 15‐year experience in a major trauma centre |
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| المؤلفون: | Anita R. Skandarajah, Benjamin N. J. Thomson, Brett Knowles, Kary Suen, Rodney Judson |
| المصدر: | ANZ Journal of Surgery. 86:894-899 |
| بيانات النشر: | Wiley, 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, Male, Resuscitation, medicine.medical_specialty, Victoria, Abdominal Injuries, 030230 surgery, Wounds, Nonpenetrating, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, Humans, Medicine, Hospital Mortality, Disease management (health), Young adult, Survival rate, Retrospective Studies, Liver injury, business.industry, Major trauma, Disease Management, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Surgery, Survival Rate, Liver, Damage control surgery, Emergency medicine, Female, business, Follow-Up Studies, Forecasting |
| الوصف: | Background Worldwide, the evolution of management of liver injury has resulted in improved outcomes. The aim of this study was to examine the trend in the management and outcomes of patients with liver injury. Primary outcomes were defined as mortality and hospital length of stay. The secondary aim was to identify independent predictors of mortality. Methods This study utilized hospital trauma registry data of all trauma patients with liver injuries admitted from 1999 to 2013. Patients in this 15-year period were divided into three periods of 5 years each and compared in terms of demographics, management and outcomes. Results A total of 725 patients with hepatic trauma were included. Patient demographics were similar, except for an increase in patient transfers from rural locations. Non-operative management increased significantly. There was a significant increase in the use of damage control surgery with perihepatic packing in high-grade liver injuries managed operatively. Hepatic angioembolization commenced midway through the study period. The overall mortality decreased by approximately threefold (P < 0.001) and mortality within 24 h of arrival to hospital by approximately fivefold (P < 0.001). Controlling for independent predictive factors of mortality, the mortality within 24 h reduced from 18.8% in period 1 to 3.6% in period 3 (P = 0.001). Conclusions At this institution, an integrated trauma service has led to an evolution in the management of hepatic trauma, favouring non-operative management, damage control surgery and the use of hepatic angioembolization. We experienced a significantly improved mortality within 24 h of arrival to hospital in patients with liver trauma. |
| تدمد: | 1445-2197 1445-1433 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f9ba36a2bf4ad86e4acf6eb09f9662fb https://doi.org/10.1111/ans.13248 |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....f9ba36a2bf4ad86e4acf6eb09f9662fb |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14452197 14451433 |
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