Decision Making by CT Grading in Blunt Hepatic Injury Patient

ABSTRACT

BACKGROUND: Because of increased number of traffic and industrial accidents, the incidence of blunt abdominal injury patients has increased. Recently, abdominal computed tomographic(CT) scans have been widely used in emergency departments for initial diagnostic workups on patients with blunt hepatic injuries. The purpose of this study is to analyze the correlation between abdominal CT scans and the clinical outcomes and to recommend a direction for the management of blunt hepatic injury. METHODS: A retrospective review was conducted of 66 patients with blunt hepatic injuries who underwent abdominal CT scans and were treated at the Department of Emergency Medicine of Dankook University Hospital during the period from January 1998 to December 2000. Statistical analysis was performed using the chi-square(x2) test, Spearman correlation test, Cochran-Mantel-Haenszel chi-square(x2) test and Fisher's exact test; a value of p<0.05 was considered significant. RESULTS: Based on CT scans, we graded the liver injuries by using the system of the Organ Injury Scaling Committee of American Association for the Surgery of Trauma. Grade II injuries(28 cases, 42.4%) were the most common in this study. Most patients with injuries above grade III were managed surgically, and CT grades correlated well with operative treatment and initial fluid resuscitation. Initial shock status correlated with the CT grade, but did not correlate with operative management. For nonoperative management, as the CT grade increased, the amount of blood transfusion also increased. Increasing liver enzyme did not correlate with CT grade. The mortality rate was 9.1%, and the most common cause of death were hypovolemic shock due to massive bleeding. CONCLUSION: Non-operative management is the first choice of treatment in low grade blunt hepatic injury(CT grade I, II, and III). For cases above grade IV hepatic injury, the key points of operative management were the hepatic injury itself and it's complication.