Improved mortality in the management of liver injuries

Closed liver injury: An assessment of prognostic factors

“…The reports of Mikesky, Howard, and De Bakey (1956) and Kindling, Wilson, and Walt (1969) suggest also that the combination of liver and spleen injury is lethal. However, splenic rupture in this series did not have a significant effect on the mortality, agreeing with the finding of Little and Williams (1969). There was also no significant relation between the presence of gastro-intestinal injury and the death of the patient, and this conclusion is in accord with other authors' published results.…”

“…As with secondary haemorrhage, the amount of blood transfused has been used as a retrospective index of outcome (Little and Williams, 1969;Amerson and Stone, 1970). In our series a significant influence was not observed, but this may represent inadequate recording when very massive transfusions I7 were given in desperate circumstances usually associated with subsequent death.…”

“…Although scintiscanning was used only three times-each with positive results-between 1959 and 1969 it has been employed increasingly during the past 3 years (Dugdale, Rosengarten, and Dudley, 1973). It adds considerably to the more conventional techniques, although careful scrutiny of plain radiographs both for rib fractures and soft-tissue shadows may be helpful in about one-third of the patients (Little and Williams, 1969). In the later stages of management scanning may also have a place in detecting residual areas of necrosis which may presage the development of an abscess or posttraumatic haemobilia.…”

Hepatic resection for trauma, tumour and biliary obstruction

“…Such arguments are valid but should be tempered by the realization that it is difficult to determine the true mortality of liver injury alone. Factors such as speed of transfer to hospital, the number of other organs injured and the experience of the surgical team should be taken into account and mortality figures of 30 per cent or less are now regularly recorded (Little and Williams, 1969;Walt, 1969;Blumgart and Vajrabukka, 1972). In our experience, 3 out of 15 patients (20 per cent) have died following resection for major blunt injury.…”

Abdominal trauma: a report of 129 cases

“…The overall mortality of ruptured liver in this series was 29%, but when major liver injuries alone are considered the mortality rose to 57%. Little & Williams (1969) found an overall mortality of 24 %, but Clarke (1954) had a 50% mortality in eighteen cases.…”