Skip to main content
SpringerLink
Log in

Blunt Liver Injuries in Polytrauma: Results from a Cohort Study with the Regular Use of Whole-body Helical Computed Tomography

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The estimated prevalence of liver injury in patients with blunt multiple trauma ranges from 1% to 8%. The objective of this study was to investigate the profile of accompanying liver injury in a cohort of polytraumatized patients who had regularly undergone contrast-enhanced, whole-body helical computed tomography (CT). We enrolled consecutive patients admitted between September 1997 and January 2001 to a level I trauma center. Clinical baseline data were compiled as part of a nationwide trauma registry. Morphologic features were evaluated descriptively, whereas prognostic variables were assessed by logistic regression analysis. We identified 218 patients [149 men, mean age 35 ± 18 years, mean injury severity score (ISS) 35 ± 10], 55 of whom had sustained blunt liver trauma [25.2%, 95% confidence interval (CI) 19.6–31.5%]. The prevalence of Moore III to V lesions was 10.1%. There were 99 parenchymal contusions, 15 capsular tears, and 2 liver fractures. Surgery was required in 15 patients and was best predicted by the classification of the American Association for the Surgery of Trauma [odds ratio (OR) 3.91, 95% CI 1.59–9.61]. The mortality rate was 0.0035/person/day. Patients requiring surgical repair had fourfold increased relative odds of case fatality (OR 4.50, 95% CI 1.01–19.96). Sevenfold increased relative odds were observed if liver laceration was considered the leading injury (OR 7.17, 95% CI 1.17–43.97). The prevalence of liver lacerations among multiple-trauma patients is likely to be underestimated and must be determined by the independent application of reference standards, such as helical CT. High-grade hepatic injuries and the need for surgical repair are associated with poorer survival prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others

References

  1. Hoff WS, Holevar M, Nagy KK, et al. (2001) Practice management guidelines for the evaluation of blunt abdominal trauma. EAST Practice Management Guidelines Work Group. Available at http://www.east.org (last date of access: June 2002)

  2. ER Thal DM Meyer (1991) ArticleTitleThe evaluation of blunt abdominal trauma: computed tomography scan, lavage, or sonography? Adv. Surg. 24 201–228 Occurrence Handle1:STN:280:By6C2czlvFw%3D

    CAS  Google Scholar 

  3. CD Becker G Mentha F Terrier (1998) ArticleTitleBlunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen Eur. Radiol. 8 553–562 Occurrence Handle1:STN:280:DyaK1c3jslyhtA%3D%3D

    CAS  Google Scholar 

  4. MG Ochsner (2001) ArticleTitleFactors of failure for nonoperative management of blunt liver and splenic injuries World J. Surg. 25 1393–1396 Occurrence Handle1:STN:280:DC%2BD38%2FjtlSntQ%3D%3D

    CAS  Google Scholar 

  5. TA Amoroso (1999) ArticleTitleEvaluation of the patient with blunt abdominal trauma: an evidence based approach Emerg. Med. Clin. North Am. 17 63–75 Occurrence Handle1:STN:280:DyaK1M3gtFGmtQ%3D%3D

    CAS  Google Scholar 

  6. R Jhirad D Boone (1998) ArticleTitleComputed tomography for evaluating blunt abdominal trauma in the low-volume nondesignated trauma center: the procedure of choice? J. Trauma 45 64–68 Occurrence Handle1:STN:280:DyaK1czktlKjug%3D%3D

    CAS  Google Scholar 

  7. BR Boulanger BA McLellan FD Brenneman et al. (1996) ArticleTitleEmergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma J. Trauma 40 867–874 Occurrence Handle1:STN:280:BymB2M7itlc%3D

    CAS  Google Scholar 

  8. MG McKenney L Martin K Lentz et al. (1996) ArticleTitle1,000 Consecutive ultrasounds for blunt abdominal trauma J. Trauma 40 607–610 Occurrence Handle1:STN:280:BymC1crps1c%3D

    CAS  Google Scholar 

  9. T Mele K Stewart B Marokus et al. (1999) ArticleTitleEvaluation of a diagnostic protocol using screening diagnostic peritoneal lavage with selective use of abdominal computed tomography in blunt abdominal trauma J. Trauma 46 847–852 Occurrence Handle1:STN:280:DyaK1M3mvVOhtg%3D%3D

    CAS  Google Scholar 

  10. HC Shih YS Wen TJ Ko et al. (1999) ArticleTitleNoninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy World J. Surg. 23 265–270 Occurrence Handle1:STN:280:DyaK1M7jsVCqsg%3D%3D

    CAS  Google Scholar 

  11. MA Healey RK Simons RJ Winchell et al. (1996) ArticleTitleA prospective evaluation of abdominal ultrasound in blunt abdominal trauma: is it useful? J. Trauma 40 875–885 Occurrence Handle1:STN:280:BymB2M7itlA%3D

    CAS  Google Scholar 

  12. KL McKenney DB Nunez MG McKenney et al. (1998) ArticleTitleSonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients Am. J. Radiol. 170 979–985 Occurrence Handle1:STN:280:DyaK1c7ptFSkug%3D%3D

    CAS  Google Scholar 

  13. GS Rozycki RB Ballard DV Feliciano et al. (1998) ArticleTitleSurgeon-performed ultrasound for the assessment of truncal injuries; lessons learned from 1540 patients Ann. Surg. 228 557–567 Occurrence Handle1:STN:280:DyaK1M%2FgsFSjtw%3D%3D

    CAS  Google Scholar 

  14. BR Boulanger FD Brenneman AW Kirkpatrick et al. (1998) ArticleTitleThe indeterminate abdominal sonogram in multisystem blunt trauma J. Trauma 45 52–56 Occurrence Handle1:STN:280:DyaK1czktlKjtA%3D%3D Occurrence Handle9680012

    CAS  PubMed  Google Scholar 

  15. O Blow D Bassam K Butler et al. (1998) ArticleTitleSpeed and efficiency in the resuscitation of blunt abdominal trauma patients with multiple injuries: the advantage of diagnostic peritoneal lavage over abdominal computerized tomography J. Trauma 44 287–290 Occurrence Handle1:STN:280:DyaK1c7lvValtg%3D%3D Occurrence Handle9498499

    CAS  PubMed  Google Scholar 

  16. Rothman, KJ, Greenland, S (1998) Modern Epidemiology, Lippincott Williams & Wilkins, Philadelphia

  17. . . (1994) ArticleTitleArbeitsgemeinschaft “Scoring” der Deutschen Gesellschaft für Unfallchirurgie (DGU): das Traumaregister der Deutschen Gesellschaft für Unfallchirurgie Unfallchirurg 97 230–237 Occurrence Handle8197471

    PubMed  Google Scholar 

  18. M Bardenheuer U Obertacke C Waydhas et al. (2000) ArticleTitleEpidemiologie des Schwerstverletzten: eine prospektive Erfassung der prôklinischen und klinischen Versorgung Unfallchirurg 103 355–363 Occurrence Handle1:STN:280:DC%2BD3cvktVOnsA%3D%3D Occurrence Handle10883594

    CAS  PubMed  Google Scholar 

  19. International Epidemiological Association/European Group (2002) Good epidemiological practice (GEP): proper conduct in epidemiological research, draft. Available at http://www.dundee.ac.uk/iea (last date of access: June 2002)

  20. US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research (1996) Good clinical practice: consolidated guidance. Available at http://www.fda.gov/cder/guidance/959fnl.pdf (last date of access: June 2002)

  21. Association for the Advancement of Automotive Medicine (1990) The Abbreviated Injury Scale (AIS) 1990 Revision, Association for the Advancement of Automotive Medicine, Barrington, IL

  22. S Mutze C Madeja S Paris et al. (1999) ArticleTitleHelical CT examination of multiple trauma patients in a digitized radiology department Emerg. Radiol. 6 77–80

    Google Scholar 

  23. G Rademacher D Stengel S Siegmann et al. (2002) ArticleTitleOptimization of contrast agent volume for helical CT in the diagnostic assessment of patients with severe and multiple injuries J. Comput. Assist. Tomogr. 26 113–118 Occurrence Handle11801913

    PubMed  Google Scholar 

  24. EE Moore SR Shackford HL Pachter et al. (1989) ArticleTitleOrgan injury scaling: spleen, liver, and kidney J. Trauma 29 1664–1666 Occurrence Handle1:STN:280:By%2BD1c%2FgsVE%3D

    CAS  Google Scholar 

  25. EE Moore TH Cogbill GJ Jurkovich et al. (1995) ArticleTitleOrgan injury scaling: spleen and liver (1994 revision) J. Trauma 38 323–324 Occurrence Handle1:STN:280:ByqB3crks1A%3D

    CAS  Google Scholar 

  26. DW Hosmer S Lemeshow (2000) Applied Logistic Regression John Wiley & Sons New York

    Google Scholar 

  27. NF Hodgson TC Stewart MJ Girotti (2000) ArticleTitleAutopsies and death certification in deaths due to blunt trauma: what are we missing? Can. J. Surg. 43 130–136 Occurrence Handle1:STN:280:DC%2BD3c3nt1ahug%3D%3D

    CAS  Google Scholar 

  28. TV Clancy JG Maxwell DL Covington et al. (2001) ArticleTitleA statewide analysis of level I and II trauma centers for patients with major injuries J. Trauma 51 346–351 Occurrence Handle1:STN:280:DC%2BD3Mvls1Ghtg%3D%3D

    CAS  Google Scholar 

  29. R Rutledge JP Hunt CW Lentz et al. (1995) ArticleTitleA statewide, population-based time-series analysis of the increasing frequency of nonoperative management of abdominal solid organ injury Ann. Surg. 222 311–326 Occurrence Handle1:STN:280:ByqH3cjps1A%3D

    CAS  Google Scholar 

  30. North Carolina Department of Health and Human Services (2002) County Health Data Book: Morbidity. Available at http://www.schs.state.nc.us/SCHS/healthstats/databook/ (last date of access: June 2002)

  31. D Stengel K Bauwens J Sehouli et al. (2001) ArticleTitleSystematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma Br. J. Surg. 88 901–912 Occurrence Handle1:STN:280:DC%2BD3MvhtlemtA%3D%3D

    CAS  Google Scholar 

  32. A Hagiwara A Murata T Matsuda et al. (2002) ArticleTitleThe efficacy and limitations of transarterial embolization for severe hepatic injury J. Trauma 52 1091–1096 Occurrence Handle12045635

    PubMed  Google Scholar 

  33. Matthes G, Stengel D, Seifert J, et al. Liver injury in polytrauma [poster-abstract P7.14]. Presented at the 9th International Conference on Emergency Medicine, Edinburgh, 2002

  34. MA Croce TC Fabian PG Menke et al. (1995) ArticleTitleNonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients Ann. Surg. 221 744–755 Occurrence Handle1:STN:280:ByqA3Mvkt1Y%3D

    CAS  Google Scholar 

  35. HL Pachter FC Spencer SR Hofstetter et al. (1992) ArticleTitleSignificant trends in the treatment of hepatic trauma: experience with 411 injuries Ann. Surg. 215 492–500 Occurrence Handle1:STN:280:By2A3MzhtlI%3D

    CAS  Google Scholar 

  36. JD Richardson GA Franklin JK Lukan et al. (2000) ArticleTitleEvolution in the management of hepatic trauma: a 25-year perspective Ann. Surg. 232 324–330 Occurrence Handle10973382

    PubMed  Google Scholar 

  37. MA Delgado Millán PO Deballon (2001) ArticleTitleComputed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma World J. Surg. 25 1397–1402 Occurrence Handle11760741

    PubMed  Google Scholar 

  38. JW Johnson VH Gracias R Gupta et al. (2002) ArticleTitleHepatic angiography in patients undergoing damage control laparotomy J. Trauma 52 1102–1106 Occurrence Handle12045637

    PubMed  Google Scholar 

  39. WL Wahl KS Ahrns MM Brandt et al. (2002) ArticleTitleThe need for early angiographic embolization in blunt liver injuries J. Trauma 52 1097–1101 Occurrence Handle12045636

    PubMed  Google Scholar 

  40. GC Velmahos S Chahwan A Falabella et al. (2000) ArticleTitleAngiographic embolization for intraperitoneal and retroperitoneal injuries World J. Surg. 24 539–545 Occurrence Handle1:STN:280:DC%2BD3c3ks1Omtg%3D%3D

    CAS  Google Scholar 

  41. GC Velmahos KG Toutouzas P Vassiliu et al. (2002) ArticleTitleA prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries J. Trauma 53 303–308 Occurrence Handle12169938

    PubMed  Google Scholar 

  42. A Hagiwara T Yukioka S Ohta et al. (1997) ArticleTitleNonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization AJR. Am. J. Roentgenol. 169 1151–1156 Occurrence Handle1:STN:280:ByiH2Mzos1Q%3D

    CAS  Google Scholar 

  43. CR Taylor L Degutis R Lange et al. (1998) ArticleTitleComputed tomography in the initial evaluation of hemodynamically stable patients with blunt abdominal trauma: impact of severity of injury scale and technical factors on efficacy J. Trauma 44 893–901 Occurrence Handle1:STN:280:DyaK1c3msVagtg%3D%3D

    CAS  Google Scholar 

  44. LM Napolitano ME Greco A Rodriguez et al. (2001) ArticleTitleGender differences in adverse outcomes after blunt trauma J. Trauma 50 274–280 Occurrence Handle1:STN:280:DC%2BD3M7psFyqsw%3D%3D

    CAS  Google Scholar 

  45. P Navarrete-Navarro G Vazquez JM Bosch et al. (1996) ArticleTitleComputed tomography vs clinical and multidisciplinary procedures for early evaluation of severe abdomen and chest trauma: a cost analysis approach Intensive Care Med. 22 208–212 Occurrence Handle1:STN:280:BymB2snmtFY%3D

    CAS  Google Scholar 

  46. MB Farnell MP Spencer E Thompson et al. (1988) ArticleTitleNonoperative management of blunt hepatic trauma in adults Surgery 104 748–756 Occurrence Handle1:STN:280:BiaD3MbnvFc%3D

    CAS  Google Scholar 

  47. M Liu CH Lee FK P’eng (1993) ArticleTitleP’eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma J. Trauma 35 267–270 Occurrence Handle1:STN:280:ByyA28%2FjtVM%3D

    CAS  Google Scholar 

  48. MG Ochsner MM Knudson L Pachter et al. (2000) ArticleTitleSignificance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: a multicenter analysis J. Trauma 49 505–510 Occurrence Handle1:STN:280:DC%2BD3cvkvFenug%3D%3D

    CAS  Google Scholar 

  49. KJ Brasel CJ Olson RE Stafford et al. (1998) ArticleTitleIncidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma J. Trauma 44 889–892 Occurrence Handle1:STN:280:DyaK1c3msVagsQ%3D%3D

    CAS  Google Scholar 

  50. B Leidner M Adiels P Aspelin et al. (1998) ArticleTitleStandardized CT examination of the multitraumatized patient Eur. Radiol. 8 1630–1638 Occurrence Handle1:STN:280:DyaK1M%2FosVSjug%3D%3D

    CAS  Google Scholar 

  51. CF Madsen GS Myrtue (1996) ArticleTitleCT i den initiale traumediagnostik Ugeskr. Laeger 158 7241–7245 Occurrence Handle1:STN:280:ByiC2cvgtFM%3D

    CAS  Google Scholar 

  52. R Löw C Duber F Schweden et al. (1997) ArticleTitleGanzkörper-Spiral-CT zur Primôrdiagnostik polytraumatisierter Patienten unter Notfallbedingungen Fortschr. Geb. Rontgenstr. Neuen. Bildgeb. Verfahr. 166 382–388

    Google Scholar 

  53. K Okamoto H Norio N Kaneko et al. (2002) ArticleTitleUse of early-phase dynamic spiral computed tomography for the primary screening of multiple trauma Am. J. Emerg. Med. 20 528–534 Occurrence Handle12369027

    PubMed  Google Scholar 

  54. M Rieger H Sparr R Esterhammer et al. (2002) ArticleTitleModerne CT-Diagnostik des akuten Thorax- und Abdominaltraumas Radiologe 42 556–563

    Google Scholar 

  55. R Kloppel D Schreiter J Dietrich et al. (2002) ArticleTitleFrühes klinisches Management nach Polytrauma mit 1- und 4-Schicht-Spiral-CT Radiologe 42 541–546

    Google Scholar 

  56. U Linsenmaier M Krotz H Hauser et al. (2002) ArticleTitleWhole-body computed tomography in polytrauma: techniques and management Eur. Radiol. 12 1728–1740 Occurrence Handle12111064

    PubMed  Google Scholar 

  57. PJ Schenarts J Diaz C Kaiser et al. (2001) ArticleTitleProspective comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status J. Trauma 51 663–668 Occurrence Handle1:STN:280:DC%2BD3Mrls1Krsw%3D%3D

    CAS  Google Scholar 

  58. PR Miller MA Croce TK Bee et al. (2001) ArticleTitleARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients J. Trauma 51 223–228 Occurrence Handle1:STN:280:DC%2BD3Mvks1Kkuw%3D%3D

    CAS  Google Scholar 

  59. LM Jelly DR Evans MJ Easty et al. (2000) ArticleTitleRadiography versus spiral CT in the evaluation of cervicothoracic junction injuries in polytrauma patients who have undergone intubation Radiographics 20 S251–S259 Occurrence Handle11046175

    PubMed  Google Scholar 

  60. SJ Pereira DP O’Brien FA Luchette et al. (2000) ArticleTitleDynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture Surgery 128 678–685 Occurrence Handle1:STN:280:DC%2BD3M%2Fhsl2mtg%3D%3D Occurrence Handle11015102

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments.

The authors thank Dr. Barbara Herzberger for editorial assistance. We are indebted to Dr. Dirk Stockheim and the referee team of the World Journal of Surgery for critical discussion and fruitful remarks. Gerrit Matthes and Dirk Stengel contributed equally to this work.

Author information

Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin Trauma Center, Warener Strasse 7, 12683, Berlin, Germany

    Gerrit Matthes M.D., Dirk Stengel M.D., Julia Seifert M.D. & Axel Ekkernkamp M.D., Ph.D.

  2. Department of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University, Friedrich Loeffler Strasse 23b, 17489, Greifswald, Germany

    Gerrit Matthes M.D., Dirk Stengel M.D., Julia Seifert M.D. & Axel Ekkernkamp M.D., Ph.D.

  3. Clinical Epidemiology, Unfallkrankenhaus Berlin Trauma Center, Warener Strasse 7, 12683, Berlin, Germany

    Dirk Stengel M.D.

  4. Institute of Radiology, Unfallkrankenhaus Berlin Trauma Center, Warener Strasse 7, 12683, Berlin, Germany

    Grit Rademacher M.D. & Sven Mutze M.D., Ph.D.

Authors
  1. Gerrit Matthes M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dirk Stengel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Seifert M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grit Rademacher M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sven Mutze M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Axel Ekkernkamp M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dirk Stengel M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matthes, G., Stengel, D., Seifert, J. et al. Blunt Liver Injuries in Polytrauma: Results from a Cohort Study with the Regular Use of Whole-body Helical Computed Tomography. World J. Surg. 27, 1124–1130 (2003). https://doi.org/10.1007/s00268-003-6981-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-003-6981-0

Keywords

Search

Navigation