Treatment Strategy for Hepatic Injury

Abstract

(Background) In our department, classification of the responsiveness to fluid resuscitation and a simple and practical damage control surgery (DCS) scoring system have been used to determine the efficacy of the treatment strategy in trauma patients. (Cases and Methods) We examined 247 out of 289 hepatic injury patients, excluding cardiopulmonary arrest cases. The present study was undertaken to establish a valid strategy for the treatment of hepatic injury, and further improvement of the survival rate was evaluated based on the incidence of grade IIIb (JAST) hepatic injury necessitating emergency room laparotomy. (Result) Interventional Radiology (IVR) treatment cases were all stable or responder patients and all survived with effective hemostasis. Transient responder or non responder patients that needed hemostasis were treated with emergency laparotomy, and all the cases that eventually expired needed DCS. The mean injury severity score (ISS) was 42.3, the mean probability of survival (Ps) was 0.413, and hemostasis treatment was started within a mean of 39.1 minutes, yielding a survival rate of 42.9 % in the cases with grade IIIb (JAST) liver injury that needed emergency room laparotomy. (Conclusion) Our criteria for deciding on the therapeutic strategy based on the response to the initial fluid resuscitation seemed to be useful from the viewpoint of hemostasis for liver injury. The key to securing quality regional trauma care is to designate a trauma care hospital as a trauma center and to transport severely injured patients to the center as rapidly as possible.