Classification of Liver Trauma

The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma.

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Injuries to the Spleen and Diaphragm

DeckerMed Surgery ◽

10.2310/surg.2169 ◽

2020 ◽

Author(s):

Andrea M. Long ◽

Preston R Miller ◽

J. Jason Hoth

Keyword(s):

Motor Vehicle ◽

Gunshot Wounds ◽

Organ Injury ◽

Trauma Patients ◽

Left Hemithorax ◽

Stab Wounds ◽

Computed Tomographic ◽

Abdominal Organs ◽

Left Diaphragm ◽

Liver Injuries

The spleen is one of the most commonly injured abdominal organs in blunt trauma patients. The mechanisms of injury are similar to those seen with liver injuries: motor vehicle collisions, automobile-pedestrian collisions, falls, and any type of penetrating injury. Stab wounds to the abdomen are less likely to cause spleen injury compared with liver injury due to the spleen’s protected location. Stab wounds to the spleen typically result in direct linear tears, whereas gunshot wounds result in significant cavitary injuries. This review covers injuries to the spleen and injuries to the diaphragm. Figures show findings on imaging that may be associated with failure of nonoperative management for splenic injuries, intraparenchymal splenic blush noted on an initial computed tomographic scan, the first step in mobilizing the spleen by making an incision in the peritoneum and the endoabdominal fascia, beginning at the inferior pole and continuing posteriorly and superiorly, splenorrhaphy performed using interrupted mattress sutures through pledgets along the raw edge of the spleen, left diaphragm ruptures evident with the gastric bubble located in the left hemithorax, whereas right-sided ruptures present with the appearance of an elevated hemidiaphragm, and the use of Allis clamps to approximate the diaphragmatic edges, with the defect closed with a running No. 1 polypropylene suture. The table lists American Association for the Surgery of Trauma organ injury scales for diaphragm and spleen. This review contains 6 figures, 1 table, and 55 references Keywords: spleen, injury grading, angioembolization, splenorrhaphy, splenic salvage

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Fall-related mortality in southern Sweden: a multiple cause of death analysis, 1998–2014

Injury Prevention ◽

10.1136/injuryprev-2017-042425 ◽

2017 ◽

Vol 25 (2) ◽

pp. 129-135 ◽

Cited By ~ 5

Author(s):

Aliasghar A Kiadaliri ◽

Björn E Rosengren ◽

Martin Englund

Keyword(s):

Cause Of Death ◽

Temporal Trends ◽

Circulatory System ◽

Southern Sweden ◽

Classification Of Diseases ◽

Icd 10 ◽

International Statistical Classification ◽

The Mean ◽

Related Mortality

ObjectivesTo investigate temporal trend in fall mortality among adults (aged ≥20 years) in southern Sweden using multiple cause of death data.MethodsWe examined all death certificates (DCs, n=2 01 488) in adults recorded in the Skåne region during 1998–2014. We identified all fall deaths using International Statistical Classification of Diseases (ICD)-10 codes (W00-W19) and calculated the mortality rates by age and sex. Temporal trends were evaluated using joinpoint regression and associated causes were identified by age-adjusted and sex-adjusted observed/expected ratios.ResultsFalls were mentioned on 1.0% and selected as underlying cause in 0.7% of all DCs, with the highest frequency among those aged ≥70 years. The majority (75.6%) of fall deaths were coded as unspecified fall (ICD-10 code: W19) followed by falling on or from stairs/steps (7.7%, ICD-10 code: W10) and other falls on the same level (6.3%, ICD-10 code: W18). The mean age at fall deaths increased from 77.5 years in 1998–2002 to 82.9 years in 2010–2014 while for other deaths it increased from 78.5 to 79.8 years over the same period. The overall mean age-standardised rate of fall mortality was 8.3 and 4.0 per 1 00 000 person-years in men and women, respectively, and increased by 1.7% per year in men and 0.8% per year in women during 1998–2014. Head injury and diseases of the circulatory system were recorded as contributing cause on 48.7% of fall deaths.ConclusionsThere is an increasing trend of deaths due to falls in southern Sweden. Further investigations are required to explain this observation particularly among elderly men.

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P9 Impact of the relocation of a regional neuroscience service on major trauma patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.89 ◽

2019 ◽

Vol 90 (3) ◽

pp. e28.2-e28

Author(s):

C Cabaret ◽

M Nelson ◽

M Foroughi

Keyword(s):

Major Trauma ◽

Strong Association ◽

Trauma Centre ◽

Trauma Patients ◽

Major Trauma Centre ◽

Significant Difference ◽

Ct Head ◽

The Mean ◽

The Impact ◽

Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

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Ionising radiation exposure in paediatric trauma

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021677313 ◽

2014 ◽

Vol 96 (3) ◽

pp. 190-193 ◽

Cited By ~ 6

Author(s):

NG Patel ◽

AM Mohamed ◽

G Cooper ◽

I McFadyen

Keyword(s):

Radiation Exposure ◽

Intraoperative Imaging ◽

Trauma Surgery ◽

Trauma Centre ◽

Ionising Radiation ◽

Trauma Patients ◽

Long Term Effects ◽

Paediatric Trauma ◽

Intraoperative Management ◽

The Mean

Introduction Trauma remains the highest cause of paediatric morbidity and mortality. These trauma patients incur radiation exposure during intraoperative management. Medical personnel have the responsibility to ensure observation of the ‘as low as reasonably achievable’ principle, a practice mandate that minimises ionising radiation exposure. The aim of this study was to quantify the difference in the amount of ionising radiation used by operating surgeons of different grades in paediatric trauma surgery. Methods Intraoperative imaging in paediatric trauma surgery between 2008 and 2010 at a UK trauma centre was analysed retrospectively, recording injury demographics, surgeon grade, radiation exposure (dose area product [DAP]) and screening time. A mobile image intensifier was used in all cases and the lowest dose rate was selected for all screening. Results A total of 782 trauma cases were analysed: 304 procedures (39%) were carried out by consultants, 127 (16%) by senior registrars and 351 (45%) by junior registrars. The mean screening time for consultants was 0.23 minutes (standard deviation [SD]: 0.21 minutes) while for senior registrars it was 0.24 minutes (SD: 0.27 minutes) and for junior registrars 0.47 minutes (SD: 1.5 minutes). The mean DAP for consultants was 58.49Gycm2 (SD: 53.66Gycm2). For senior registrars it was 87.2Gycm2 (SD: 126.64Gycm2) and for junior registrars it was 90.46Gycm2 (SD: 180.02Gycm2). This equates to a 51% increase in screening time and a 35% increase in DAP by a junior registrar compared with a consultant. Conclusions Significantly lower screening times and radiation exposure was found in procedures performed by consultants compared with registrars (p<0.001). Given the harmful and unknown long-term effects of ionising radiation exposure in children, we recommend increasing consultant presence in paediatric trauma theatres.

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Surgical Management of Complex Liver Trauma: A Single Liver Transplant Center Experience

The American Surgeon ◽

10.1177/000313481207800113 ◽

2012 ◽

Vol 78 (1) ◽

pp. 20-25 ◽

Cited By ~ 9

Author(s):

Sergio Li Petri ◽

Salvatore Gruttadauria ◽

Duilio Pagano ◽

Gabriel J. Echeverri ◽

Fabrizio Di Francesco ◽

...

Keyword(s):

Liver Resection ◽

Liver Injury ◽

Damage Control ◽

Length Of Hospital Stay ◽

Operative Management ◽

Liver Trauma ◽

Organ Injury ◽

Transplant Center ◽

Liver Injuries ◽

Mechanism Of Trauma

Complex liver trauma often presents major diagnostic and management problems. Current operative management is mainly centered on packing, damage control, and early utilization of interventional radiology for angiography and embolization. In this retrospective observational study of patients admitted to the Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy, from 1999 to 2010, we included patients that underwent hepatic resection for complex liver injuries (grade I to Vaccording to the American Association for the Surgery of Trauma-Organ Injury Scale). Age, gender, mechanism of trauma, type of resection, surgical complications, length of hospital stay, and mortality were the variables analyzed. A total of 53 adult patients were admitted with liver injury and 29 underwent surgical treatment; the median age was 26.7 years. Mechanism was blunt in 52 patients. The overall morbidity was 30 per cent, morbidity related to liver resection was 15.3 per cent. Mortality was 2 per cent in the series of patients undergoing liver resection for complex hepatic injury, whereas in the nonoperative group, morbidity was 17 per cent and mortality 2 per cent. Liver resection should be considered a serious surgical option, as initial or delayed management, in patients with complex liver injury and can be accomplished with low mortality and liver-related morbidity when performed in specialized liver surgery/transplant centers.

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Hirursko lecenje povreda jetre - petogodisnje iskustvo

Acta chirurgica iugoslavica ◽

10.2298/aci1004009b ◽

2010 ◽

Vol 57 (4) ◽

pp. 9-14

Author(s):

Djordje Bajec ◽

Dejan Radenkovic ◽

Pavle Gregoric ◽

Vasilije Jeremic ◽

Vladimir Djukic ◽

...

Keyword(s):

Penetrating Trauma ◽

Gunshot Wounds ◽

Mortality Rates ◽

Liver Trauma ◽

Organ Injury ◽

Specific Complication ◽

Liver Injuries ◽

Severity Of Injury ◽

Significant Difference ◽

Methods Of Treatment

Due to improved methods of treatment and management of hemorrhage, the mortality from liver injuries has decreased significantly over the past few decades. In spite of that, liver injuries still represent diagnostic and therapeutic challenge. This retrospective study included 197 patients surgically treated because of trauma of the liver at The Clinic for Emergency Surgery, during the period 2004-2009. The results showed significant difference in mortality rates in cases of penetrating wounds compared to blunt trauma and gunshot wounds. The severity of injury evaluated by Organ Injury Scale was significantly higher in gunshot wounds compared to blunt and penetrating trauma. The correlation of severity of injuries and mortality rates showed that the mortality is significantly lower in patients with grade 1, 2, and 3 injuries compared to grades 4 and 5 (p=0.016). Specific complication rate was 28.4%, while mortality rate was 21.8%. The results reflect diagnostic and treatment problems, as well as the importance of multidisciplinary approach to the patients with liver trauma.

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Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2020-047439 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047439

Author(s):

Rayan Jafnan Alharbi ◽

Virginia Lewis ◽

Sumina Shrestha ◽

Charne Miller

Keyword(s):

Systematic Review ◽

Trauma Care ◽

Data Extraction ◽

Meta Analysis ◽

Trauma System ◽

Secondary Data ◽

Trauma Centre ◽

Trauma Patients ◽

Trauma Systems ◽

Stages Of Development

IntroductionThe introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.Methods and analysisThe proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.Ethics and disseminationThis systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.PROSPERO registration numberCRD42019142842.

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Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

The American Surgeon ◽

10.1177/00031348211031855 ◽

2021 ◽

pp. 000313482110318

Author(s):

Victor Kong ◽

Cynthia Cheung ◽

Nigel Rajaretnam ◽

Rohit Sarvepalli ◽

William Xu ◽

...

Keyword(s):

South Africa ◽

Small Bowel ◽

Large Bowel ◽

Major Trauma ◽

Stab Wound ◽

Length Of Hospital Stay ◽

Trauma Centre ◽

Major Trauma Centre ◽

The Mean ◽

Overall Mortality

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

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