Angiointervention: an independent predictor of survival in high-grade blunt liver injuries

• Published in: The American journal of surgery 2015-04, Vol.209 (4), p.742-746
• Main Authors: Sivrikoz, Emre, M.D, G. Teixeira, Pedro, M.D, Resnick, Shelby, M.D, Inaba, Kenji, M.D., M.Sc, Talving, Peep, M.D, Demetriades, Demetrios, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Age; Angiointervention; Coma; Confidence intervals; Embolisms; Embolization, Therapeutic; Female; Gangrene; Humans; Improved survival; Increased complications; Injuries; Injury Severity Score; Intensive care; Isolated severe liver injury; Liver - injuries; Logistics; Male; Middle Aged; Mortality; Multivariate analysis; Pneumonia; Prognosis; Respiratory distress syndrome; Sepsis; Standard deviation; Surgery; Survival Rate; Thrombosis; Ventilation; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - therapy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.06.024

Abstract Background The role of angiointervention (ANGIO) in the management of high-grade liver injuries is not clear and there are concerns about increased complications. Methods National Trauma Data Bank study, isolated grade IV and V blunt liver injuries. Patients with major associated intra-abdominal or extra-abdominal injuries were excluded. Logistic regression analysis was performed to identify independent predictors of mortality and complications. Results Six thousand four hundred two patients met the criteria for inclusion. Laparotomy was performed in 32% of the patients and nonoperative management in 68%. Overall, 11% of the patients underwent ANGIO. Patients in the ANGIO group were significantly more likely to be older than 55 years than non-ANGIO patients and more likely to have Injury Severity Scores greater than 25. After stepwise logistic regression, ANGIO was an independent predictor of survival ( P < .001). In the group of patients managed operatively, it was independently associated with a lower mortality ( P < .001). Similarly, in the nonoperative group, it was independently associated with a lower mortality (5.4% vs 9.5%, P = .008). ANGIO was associated with increased systemic complications. Conclusions ANGIO in blunt, severe liver injuries is associated with reduced mortality and increased complications, in both operative and nonoperative management.