Mortality following severe liver trauma is declining at Auckland City Hospital: a 14-year experience, 2006-2020.

INTRODUCTION: Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality.

AIM: To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications.

METHODS: A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined.

RESULTS: Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091).

CONCLUSION: Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.