Blunt Liver Trauma at SunnybrookMedical Centre: A 13 Year Experience

Abstract

Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre inToronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% beingdue to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335),99% being true positive.A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treatedconservatively (n = 3) or died during resuscitation (n = 8).Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) althoughoverall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess orhematoma accounting for 11 of 14 operations.The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, IIor III liver trauma according to Moore’s classification with a mortality of 12% (n = 32). The remaining18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for(1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage andsepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of335 patients (14% overall).Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver traumain our population of multiply injured patients from 12% (1976–1983) down to 7% (1985–1989); with agradual decline in overall mortality from 32% (1976–1983) to 19% (1985–1989), whereas the precentageof deaths due to head injuries and liver injury have increased.