Patterns of organ injury in blunt hepatic trauma and their significance for management and outcome.

Analysis of 185 consecutive patients admitted to a trauma center (1983-1986) with blunt traumatic injury to the liver classified by severity of hepatic injury (I-V) has demonstrated that the pattern of associated organ injuries is a major determinant of the immediate resuscitation requirements, complications, and the ultimate outcome of patients with hepatic injury. When the significance of all injuries and major complications was evaluated using simultaneous ANOVA techniques, only brain and chest trauma together were significant (p less than 0.03) as injuries occurring in subsequently fatal cases for all classes of blunt hepatic injury. Sepsis (p less than 0.05) and ARDS (p less than 0.005) were significant complications associated with death in the patients who survived the initial operative intervention, and only brain deterioration and exsanguinating hemorrhage were significant (p less than 0.0001) as direct causes of death in all groups of patients. It was of interest that neither associated bowel, spleen, stomach, or pancreatic injuries had a significant difference in incidence between survivors and deaths. Overall, the most important single injury determining ultimate outcome was blunt traumatic injury of the brain. Review of the resuscitation and operative intervention strategies, postoperative complications, and causes of death shows that the interactions between the class of liver injury and the injuries to other organs, primarily brain and lung, are the determinant of the optimization of postinjury therapy of both a surgical and critical care nature.