Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study
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(2020) 15:58
RESEARCH ARTICLE
Open Access
Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study Yash Sinha1, Monty U. Khajanchi2, Ramlal P. Prajapati2, Satish Dharap3, Kapil Dev Soni4, Vineet Kumar5, Santosh Mahindrakar6 and Nobhojit Roy7,8*
Abstract Background: Low- and middle-income countries (LMICs) contribute to 90% of injuries occurring in the world. The liver is one of the commonest organs injured in abdominal trauma. This study aims to highlight the demographic and management profile of liver injury patients, presenting to four urban Indian university hospitals in India. Methods: This is a retrospective registry-based study. Data of patients with liver injury either isolated or concomitant with other injuries was used using the ICD-10 code S36.1 for liver injury. The severity of injury was graded based on the World Society of Emergency Surgery (WSES) grading for liver injuries. Results: A total of 368 liver injury patients were analysed. Eighty-nine percent were males, with road traffic injuries being the commonest mechanism. As per WSES liver injury grade, there were 127 (34.5%) grade I, 96 (26.1%) grade II, 70 (19.0%) grade III and 66 (17.9%) grade IV injuries. The overall mortality was 16.6%. Two hundred sixty-two patients (71.2%) were managed non-operatively (NOM), and 106 (38.8%) were operated. 90.1% of those managed nonoperatively survived. Conclusion: In this multicentre cohort of liver injury patients from urban university hospitals in India, the commonest profile of patient was a young male, with a blunt injury to the abdomen due to a road traffic accident. Success rate of non-operative management of liver injury is comparable to other countries. Keywords: Injury, Liver injury, Non-operative management, Epidemiology of liver injury, Management
Introduction Injuries account for 4.8 million lives globally, and deaths due to road traffic injuries alone are among the top 10 causes of mortality [1, 2]. Seven to ten percent of all injuries that occur involve the abdominal region, making it the third most common region injured following traumatic brain injury (TBI) and extremity injury [3, 4].
* Correspondence: [email protected] 7 Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, Widerströmska Huset, SE-171 77 Stockholm, Sweden 8 WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital (Govt. of India), Mumbai 400094, India Full list of author information is available at the end of the article
Liver and spleen injuries are the commonest damages in blunt abdominal trauma [5]. Promising outcomes of non-operative management (NOM), in paediatric splenic injuries, have shifted the definitive treatment of these injuries from operative management (OM) to NOM [6, 7]. Higher grade injuries to the liver can be conserved if the patient is hemodynamically stable [8, 9]. NOM is based on the understanding that an injury which appears severe may not necessarily exsanguinate an
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