| A reaudit of specialist-managed liver trauma after establishment of regional referral and management guidelines. | |
| | |
MedLine Citation:
|
PMID: 20065762 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: An earlier liver trauma audit (52 patients) noted that 50% were surgically managed at referring hospitals with a high morbidity and mortality, after which a regional referral and management algorithm was implemented in 2001. This study aims to reaudit specialist-managed liver trauma outcomes. METHODS: Prospective analysis of 99 patients (68 male) treated for liver injury (LI) between 2001 and 2008. Patient characteristics, management, and outcome results of these were compared with the results of previous audit. LI severity was determined by computed tomography, operative findings, and classified according to liver Organ Injury Scale. RESULTS: As implementation of guidelines, referrals increased from 5.2 patients/yr to 14.1 patients/yr, while LI profile was unchanged. Fewer patients were managed surgically with lower surgical intervention at referring hospitals (26 of 52 [50%] vs. 29 of 77 [38%]; p = 0.2). There has been a decrease in liver resection rates (14 of 26 [54%] vs. 3 of 37 [8%]; p = 0.0001]), overall mortality rate (12 of 52 [23%] vs. 11 of 99 [11%]; p = 0.059), and postoperative deaths. CONCLUSION: This reaudit confirms the role of nonoperative management of liver trauma. Early use of computed tomography scan with specialist discussion, selective use of perihepatic packing, and transfer to a specialist unit should be standard practice in the management of complex liver trauma. |
| | |
Authors:
|
Krishnamoorthy Ramkumar; M Thamara P R Perera; Ravi Marudanayagam; Chris Coldham; Simon P Olliff; David A Mayer; Simon R Bramhall; John A C Buckels; Darius F Mirza |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 Jan |
Date Detail:
|
Created Date: 2010-01-12 Completed Date: 2010-01-28 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 84-9 Citation Subset: AIM; IM |
Affiliation:
|
Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Aged Algorithms Female Hepatectomy Hospitals, District Hospitals, General* Humans Length of Stay Liver / injuries* Male Medical Audit Medicine* Middle Aged Multiple Trauma / therapy Patient Transfer* Referral and Consultation* Tomography, X-Ray Computed Wounds, Nonpenetrating / diagnosis, surgery, therapy Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Effects of gut microflora on hepatic damage after acute liver injury in rats.
Next Document: Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage ...