Liver Trauma in South Wales: the Cardiff Protocol

The liver is the most commonly injured organ following trauma. Management of liver trauma has shifted away from surgical intervention towards non-operative management (NOM), and with careful observation, regular re-examination and utilisation of interventional radiological services, there has been an improvement in outcomes. Mortality following liver trauma is quoted at 10–15%. Patients admitted between 1st January 2009 and 31st December 2014 were identified via our Trauma Audit and Research Network (TARN) officer and from CT scan reports containing the words biloma, contusion, laceration and trauma. Liver injuries were graded by a consultant radiologist using the AAST scale. Information on interventions and outcomes was gathered from a combination of TARN data and case note review. Eighty-eight patients were identified with a median age of 26 (2–71). Fifty-one patients (58%) were male. Incidence peaked in the third decade with both men and women. Median ISS was 22 (4–59). Blunt trauma was the cause in 76 (86%) of the patients. Seven patients died prior to scanning or laparotomy. Eighteen patients required laparotomy; the remaining 63 patients were managed non-operatively. Overall mortality was 13.6%—all fatalities occurring within the blunt trauma group. Mortality following laparotomy was 22% and higher in males (15.7 vs 10.8%). Non-operative management (NOM) for liver trauma is well established at our hospital. Our mortality rate is comparable to larger series. A blunt mechanism of injury and the need for surgical intervention both represent poor prognostic factors in patients with liver trauma.