Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries

Trauma surgeons still need to operate, but angioembolization helps

Juan A. Asensio, Gustavo Roldán, Patrizio Petrone, Esther Rojo, Areti Tillou, Eric Kuncir, Demetrios Demetriades, George Velmahos, James Murray, William C. Shoemaker, Thomas V. Berne, Linda Chan, Thomas H. Cogbill, Mark G. McKenney, David V. Feliciano

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Background: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. Methods: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. Results: The study included 103 patients, with a mean Revised Trauma Score of 5.61 ± 2.55 and a mean Injury Severity Score of 33 ± 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p <0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p <0.0002), angioembolization (adjusted p <0.0177), direct approach to hepatic veins (adjusted p <0.0096), and packing (adjusted p <0.0013). Conclusion: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

Original languageEnglish
Pages (from-to)647-654
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

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Liver
Wounds and Injuries
Surgeons
oligomycin sensitivity-conferring protein
Thoracotomy
Mortality
Hospital Emergency Service
Logistic Models
Injury Severity Score
Hepatic Veins
Survival
Survival Rate
Odds Ratio
Regression Analysis
Outcome Assessment (Health Care)
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries : Trauma surgeons still need to operate, but angioembolization helps. / Asensio, Juan A.; Roldán, Gustavo; Petrone, Patrizio; Rojo, Esther; Tillou, Areti; Kuncir, Eric; Demetriades, Demetrios; Velmahos, George; Murray, James; Shoemaker, William C.; Berne, Thomas V.; Chan, Linda; Cogbill, Thomas H.; McKenney, Mark G.; Feliciano, David V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 4, 01.04.2003, p. 647-654.

Research output: Contribution to journalArticle

Asensio, JA, Roldán, G, Petrone, P, Rojo, E, Tillou, A, Kuncir, E, Demetriades, D, Velmahos, G, Murray, J, Shoemaker, WC, Berne, TV, Chan, L, Cogbill, TH, McKenney, MG & Feliciano, DV 2003, 'Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: Trauma surgeons still need to operate, but angioembolization helps', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 4, pp. 647-654. https://doi.org/10.1097/01.TA.0000054647.59217.BB
Asensio, Juan A. ; Roldán, Gustavo ; Petrone, Patrizio ; Rojo, Esther ; Tillou, Areti ; Kuncir, Eric ; Demetriades, Demetrios ; Velmahos, George ; Murray, James ; Shoemaker, William C. ; Berne, Thomas V. ; Chan, Linda ; Cogbill, Thomas H. ; McKenney, Mark G. ; Feliciano, David V. / Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries : Trauma surgeons still need to operate, but angioembolization helps. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 4. pp. 647-654.
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abstract = "Background: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. Methods: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. Results: The study included 103 patients, with a mean Revised Trauma Score of 5.61 ± 2.55 and a mean Injury Severity Score of 33 ± 9.5. Mechanism of injury was penetrating in 80 (79{\%}) and blunt in 23 (21{\%}). Emergency department thoracotomy was performed in 21 (25{\%}). AAST grade IV injuries occurred in 51 (47{\%}) and grade V injuries occurred in 52 (53{\%}). Mean estimated blood loss was 9,414 mL. Overall survival was 43{\%}. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58{\%}. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63{\%}); grade V, 12 of 52 (23{\%}); grade IV versus grade V (p <0.001) odds ratio, 2.06; 95{\%} confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p <0.0002), angioembolization (adjusted p <0.0177), direct approach to hepatic veins (adjusted p <0.0096), and packing (adjusted p <0.0013). Conclusion: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.",
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T2 - Trauma surgeons still need to operate, but angioembolization helps

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AU - Roldán, Gustavo

AU - Petrone, Patrizio

AU - Rojo, Esther

AU - Tillou, Areti

AU - Kuncir, Eric

AU - Demetriades, Demetrios

AU - Velmahos, George

AU - Murray, James

AU - Shoemaker, William C.

AU - Berne, Thomas V.

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N2 - Background: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. Methods: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. Results: The study included 103 patients, with a mean Revised Trauma Score of 5.61 ± 2.55 and a mean Injury Severity Score of 33 ± 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p <0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p <0.0002), angioembolization (adjusted p <0.0177), direct approach to hepatic veins (adjusted p <0.0096), and packing (adjusted p <0.0013). Conclusion: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

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