Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation

Eur J Trauma Emerg Surg. 2018 Feb;44(1):63-70. doi: 10.1007/s00068-017-0765-y. Epub 2017 Feb 16.

Abstract

Background: Over the last decade trauma services have undergone a reconfiguration in England and Wales. The objective is to describe the epidemiology, management and outcomes for liver trauma over this period and examine factors predicting survival.

Methods: Patients sustaining hepatic trauma were identified using the Trauma Audit and Research Network database. Demographics, management and outcomes were assessed between January 2005 and December 2014 and analysed over five, 2-year study periods. Independent predictor variables for the outcome of liver trauma were analysed using multiple logistic regression.

Results: 4368 Patients sustained hepatic trauma (with known outcome) between January 2005 and December 2014. Median age was 34 years (interquartile range 23-49). 81% were due to blunt and 19% to penetrating trauma. Road traffic collisions were the main mechanism of injury (58.2%). 241 patients (5.5%) underwent liver-specific surgery. The overall 30-day mortality rate was 16.4%. Improvements were seen in early consultant input, frequency and timing of computed tomography (CT) scanning, use of tranexamic acid and 30-day mortality over the five time periods. Being treated in a unit with an on-site HPB service increased the odds of survival (odds ratio 3.5, 95% confidence intervals 2.7-4.5).

Conclusions: Our study has shown that being treated in a unit with an on-site HPB service increased the odds of survival. Further evaluation of the benefits of trauma and HPB surgery centralisation is warranted.

Keywords: Centralisation; Hepatobiliary; Liver; Outcomes; Trauma.

MeSH terms

  • Adult
  • Antifibrinolytic Agents / therapeutic use
  • Digestive System Surgical Procedures* / mortality
  • Emergency Medicine* / standards
  • England / epidemiology
  • Female
  • Health Services Research
  • Hospital Mortality
  • Humans
  • Injury Severity Score
  • Length of Stay / statistics & numerical data*
  • Liver / injuries*
  • Liver / surgery
  • Logistic Models
  • Male
  • Outcome Assessment, Health Care
  • Survival Analysis
  • Tranexamic Acid / therapeutic use
  • Wales / epidemiology
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / surgery*
  • Wounds, Penetrating / mortality
  • Wounds, Penetrating / surgery*

Substances

  • Antifibrinolytic Agents
  • Tranexamic Acid