Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality

Tignanelli, Christopher J.; Joseph, Bellal; Jakubus, Jill L.; Iskander, Gaby; Napolitano, Lena M.; Hemmila, Mark R.

doi:10.1097/ta.0000000000001743

Cited by 23 publications

(27 citation statements)

References 21 publications

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“…Active contrast extravasation is a sign of active hemorrhage [23]. CT scan may help in subsequent Table 3 AAST liver trauma classification [24][25][26][27][28][29][30][31][32]. Diagnostic peritoneal lavage (DPL) should be considered diagnostic modality in low-resource settings, where CT scan or US is not promptly available [33].…”

Section: Diagnosismentioning

confidence: 99%

“…In any case, these patients should undergo serial blood test: increasing levels of transaminases could indicate the presence of intrahepatic parenchymal ischemia or rare cases of torsion of suprahepatic veins [64]. ICU admission may be indicated for moderate (WSES II) (AAST III) and severe (WSES III-IV) (AAST IV-V) liver trauma in order to reduce the mortality risk [26].…”

Section: Diagnosismentioning

confidence: 99%

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Liver trauma: WSES 2020 guidelines

et al. 2020

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Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Liver trauma: WSES 2020 guidelines

et al. 2020

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“…Those major complications have previously been verified to have the highest attributable mortality among trauma patients. 13,14 To evaluate all-cause in-hospital mortality, early mortality, ICU admission, major complications, and treatment strategy, we used multilevel mixed-effects logistic regression models. To evaluate time to treatment, we used mixed-effects negative binomial regression models.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that patients with high-grade solid organ injuries have improved outcomes when treated at tertiary trauma centers. 14,19 Unfortunately we were unable to evaluate transfer practices between majority, mixed-race, and minority hospitals. Hospital segregation may, in turn, affect health outcomes and service utilization differently than does residential segregation, for example, through racial differences in providers' medical practice patterns and in patients' access to high-quality providers and specialized services.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males With High-Grade Splenic Injuries

Tignanelli

Watarai

Fan

et al. 2020

The American Surgeon™

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Introduction Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries. Methods Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation. Results Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). Discussion While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

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“…Hemodynamic instability is characterized by the following: heart rate > 120 bpm, systolic blood pressure < 90 mmHg, low urine output, increased respiratory rate (>30 respirations/minute), signs of skin vasoconstriction and altered level of consciousness [22]. Non-operative management necessitates medical centers capable of an accurate injury severity diagnosis, intensive management of patients, and prompt access to diagnostic modalities, interventional radiology, operation theater, and blood-blood products [20,23]. Ultrasound plays a significant role in the proper investigation of abdominal injuries.…”

Section: Initial Assessment and Investigationmentioning

confidence: 99%

Damage Control Surgery for Liver Trauma

Ziogas¹,

Katsaros²,

Tsoulfas³

2021

Trauma and Emergency Surgery - The Role of Damage Control Surgery

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The liver is one of the most commonly injured organs of the abdomen after major trauma and may lead to the extravasation of major amounts of blood. Damage control surgery (DCS) as a concept exists for over one hundred years but has been more widely optimized and implemented over the past few decades. Minimizing the time from the trauma scene to the hospital and recognizing the patterns of injury and the "lethal triad" (acidosis, hypothermia, coagulopathy) is vital to understand which patients will benefit the most from DCS. Immediate patient resuscitation, massive blood transfusion, and taking the patient to the operating room as soon as possible are the critical initial steps that have been associated with improved outcomes. Bleeding and contamination control should be the priority in this first exploratory laparotomy, while the patient should be transferred to the intensive care unit postoperatively with only temporary abdominal wall closure. Once the patient is stabilized, a second operation should be performed where an anatomic liver resection or other more major procedures may take place, along with permanent closure of the abdominal wall.

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Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality

Abstract: Care management, level IV.

Cited by 23 publications

References 21 publications

Liver trauma: WSES 2020 guidelines

Liver trauma: WSES 2020 guidelines

Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males With High-Grade Splenic Injuries

Damage Control Surgery for Liver Trauma

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