Predictive Factors Of Morbidity And Mortality In Hepatic Trauma [fatores Preditivos De Morbidade E Mortálidade No Trauma Hepático]

Background: The aim of this study was to evaluate predictive factors of morbidity and mortality in patients operated on for liver trauma. Methods: Six hundred thirty eight patients were studied from 1990 to 2003 regarding their epidemiologic, physiologic and anatomic data and the predictive values associated with complications and death were statistically analyzed. Results: Penetrating trauma was the most frequent mechanism of trauma. Hemodynamic instability occurred in 21.1% of the victims and mean Injury Severity Score (ISS) was 20.7. Most liver injuries were grade III. Morbidity was 50.4% and the most common liver related complications were: persistent bleeding (9.8%); intraperitoneal abscess (3.8%) and biliary fistula (3%). Complications not related to the liver occurred in 273 patients (42.8%). Mortality was 22.1% (141 cases), and it occurred mainly due to persistent bleeding and sepsis. Fatal victims were more unstable during admission, with worst physiological status, more complex liver injuries and higher anatomical scores when in comparison with the other patients. Conclusion: We found that the predictive factors for liver complications were: age higher than 60 years-old, hemodynamic instability and altered physiological status during admission, complex liver injuries (grade > III), and higher anatomical scores (Abdominal Trauma Index and ISS = 25). All these variables, and the existence of associated abdominal and extra-abdominal injuries, and blunt mechanism of trauma were predictive of the occurrence of liver unrelated complications. All the studied factors, except for associated abdominal injuries, were predictive of death.356397405Pachter, H.L., Spencer, F.C., Hofstetter, S.R., Liang, H.G., Coppa, G.F., Significant trends in the treatment of hepatic trauma. 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