Liver trauma: hepatic vascular injury on computed tomography as a predictor of patient outcome

• Published in: European radiology 2021-05, Vol.31 (5), p.3375-3382
• Main Authors: Lada, Nicholas Ellerman, Gupta, Avneesh, Anderson, Stephan W., Dinh, Diana C., Campbell, John M., Maggi, Alec, Gandhi, Jasmine, Qureshi, Muhammad Mustafa, Wing, Heidi, Schulze, Robert, LeBedis, Christina A.
• Format: Article
• Language: English
• Subjects: Abdominal Injuries; Adolescent; Adult; Aged; Aged, 80 and over; Computed tomography; Criteria; Diagnostic Radiology; Disease management; Electronic health records; Electronic medical records; Evaluation; Female; Hepatobiliary-Pancreas; Humans; Imaging; Informed consent; Injuries; Injury Severity Score; Internal Medicine; Interventional Radiology; Length of stay; Liver; Liver - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Radiology; Retrospective Studies; Surgery; Tomography, X-Ray Computed; Trauma; Ultrasound; Vascular System Injuries - diagnostic imaging; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-07373-9

Objectives To evaluate hepatic vascular injury (HVI) on CT in blunt and penetrating trauma and assess its relationship to patient management and outcome. Method and materials This retrospective study was IRB approved and HIPAA compliant. Informed consent was waived. Included were patients ≥ 16 years old who sustained blunt or penetrating trauma with liver laceration seen on a CT performed at our institution within 24 h of presentation over the course of 10 years and 6 months (August 2007–February 2018). During this interval, 171 patients met inclusion criteria (123 males, 48 females; mean age 34; age range 17–80 years old). Presence of HVI was evaluated and liver injury was graded in a blinded fashion by two radiologists using the 1994 and 2018 American Association for the Surgery of Trauma (AAST) liver injury scales. Hospital length of stay and treatment (angioembolization or operative) were recorded from the electronic medical record. Multivariate linear regressions were used to determine our variables’ impact on the length of stay, and logistic regressions were used for categorical outcomes. Results Of the included liver trauma patients, 25% had HVI. Patients with HVI had a 3.2-day longer length of hospital stay on average and had a 40.3-fold greater odds of getting angioembolization compared to those without. Patients with high-grade liver injury (AAST grades IV–V, 2018 criteria) had a 3.2-fold greater odds of failing non-operative management and a 14.3-fold greater odds of angioembolization compared to those without. Conclusion HVI in liver trauma is common and is predictive of patient outcome and management. Key Points • Hepatic vascular injury occurs commonly (25%) with liver trauma. • Hepatic vascular injury is associated with increased length of hospital stay and angioembolization. • High-grade liver injury is associated with failure of non-operative management and with angioembolization.