Non-operative Management of Liver Injury among Abdominal Trauma Patients Admitted to Al-Noor Specialist Hospital in Makkah Al-Mukarmah: A Retrospective Cohort Study, 2013 – 2014
Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 5
Abstract
Background: Recently, there was a shift in the management plan for liver blunt trauma from operative to non-operative treatment, as there were advances in critical care and sensitivity of diagnostic tools for detection of liver injury such as CT scan. Objectives: To estimate the prevalence and correlates of non-operative management of liver injury among abdominal trauma patients admitted under surgical team care at Al-Noor specialist hospital in Makkah Al-Mukarmah between 2013 and 2014. Subjects and methods: This is a retrospective cohort study carried out in Al-Noor specialist hospital, Makkah Al-Mukarramah, from 2013 to 2014. All patients admitted to Al-Noor Specialist hospital in general surgery department with abdominal trauma and liver injury were included. Variables were obtained through file review. Results: The study included 54 patients with liver trauma. Their age ranged from 7 to 60 years with mean age of29.2± 11.3. Male was the dominant gender, with male to female ratio was 8 to 1. Exactly half of patients were Saudis. The prevalence of non-operative management of liver injury throughout the period 2013-2014 was 88.9%. Regarding mechanism of injury, all cases of fall down and 88.9% of road traffic accidents compared to none of penetrating injury were treated non-operatively, p=0.011. Concerning CT grading, all cases of grade I compared to 75% of grade IV and 70% of grade III were treated non- operatively, p=0.016. Systolic and diastolic pressures were significantly higher in patients managed non-operatively than those managed operatively (123.5±18.8 and 75.4±13.9 versus 92.3±41.4 and 56.0±25.9), p values were 0.002 and 0.005 for systolic and diastolic blood pressures, respectively. There was no significant difference between both groups regarding heamatological parameters except PTT as it was 48.8±30.0 in operative group and 31.7±10.0 in non-operative group, p=0.009. Majority of patients with 14-15 Glasgow coma scale (97.3%) compared to 71.4% of those of ≤8 Glasgow coma scale were treated non-operatively, p=0.014. All cases presented without associated abdominal injury compared to 70% of those presented with associated abdominal injury were managed non-operatively, p=0.002. Majority of patients treated non-operatively (45/48; 93.8%) compared to one third of those treated operatively (2/6; 33.3%) were improved on discharge, p<0.001. Conclusion: The prevalence of non-operative management of liver injury in Al-Noor hospital, Makkah is currently very high, ever for high grade injuries. Most of them were improved on discharge compared to those managed operatively.
Authors and Affiliations
Omar Abdullah Alzahrani, Fadhel Alzahrani, Mohammed Alghamdi, Meshal Alnemary, Ahmad Alrahmani
Keywords
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- EP ID EP547570
- DOI 10.21276/ijmrp.2017.3.5.044
- Views 84
- Downloads 0
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