Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

Management of Liver Injuries: The Panamerican Trauma Society 2018 Consensus Guidelines

Tarek Razek, Gregory Peck

Keywords : Consensus guidelines, Liver trauma, Management of liver injuries, Nonoperative liver trauma, Operative liver trauma, The Panamerican Trauma Society 2018 Consensus Guidelines

Citation Information : Razek T, Peck G. Management of Liver Injuries: The Panamerican Trauma Society 2018 Consensus Guidelines. Panam J Trauma Crit Care Emerg Surg 2019; 8 (3):133-138.

DOI: 10.5005/jp-journals-10030-1247

License: CC BY-NC 4.0

Published Online: 07-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Objective: The objective of this guideline is to create a framework and recommendations for best practice management of traumatic liver injuries in trauma patients cared for by surgeons in the Americas. The guidelines presented are based on an extensive literature review including international studies and data as well as in-depth consensus discussions at the 2018 Panamerican Trauma Society Liver Trauma Consensus session. Materials and methods: A PubMed literature review was performed including all relevant prospective, retrospective, meta-analysis studies, and guideline manuscripts between 1995 and 2018. Expert presentations, literature review, and guideline proposal discussions were completed at the liver trauma consensus session at the annual Panamerican Trauma Society meeting in Cartagena, Colombia 2018. Results: The literature search revealed 32 relevant studies and manuscript as a foundation for the Panamerican Trauma Society Liver Trauma Management Guidelines. Expert discussions at the liver trauma consensus sessions added important aspects unique to clinical practice in rural and urban trauma centers in Latin American countries. The developed guidelines may contribute to a more standardized and evidence-based approach to the management of patients with liver trauma in the Americas. Conclusion: Liver trauma consensus sessions and detailed literature review were effective in completing a Panamerican Trauma Society consensus guidelines manuscript for the management of patients with liver trauma. The guidelines may assist physicians in the provision of a standard and effective approach to the management of patients with liver trauma across the Americas with the intent to improve outcomes and outcomes measurement.

  1. Organization WH. Injuries and violence: the facts. https://wwwwhoint/violence_injury_prevention/key_facts/en/, 2010.
  2. Feliciano DV, Mattox KL, Jordan Jr GL, et al. Management of 1000 consecutive cases of hepatic trauma (1979–1984). Ann Surg 1986;204(4):438–445. DOI: 10.1097/00000658-198610000-00012.
  3. Newgard CD, Fu R, Bulger E, et al. Evaluation of rural vs urban trauma patients served by 9-1-1 emergency medical services. JAMA Surg 2017;152(1):11–18. DOI: 10.1001/jamasurg.2016.3329.
  4. West S, King V, Carey TS, et al. Systems to rate the strength of scientific evidence. Evid Rep Technol Assess (Summ) 2002;47:1–11.
  5. Di Saverio S, Catena F, Filicori F, et al. Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre. Injury 2012;43(9):1347–1354. DOI: 10.1016/j.injury.2012.01.003.
  6. Atkins D, Briss PA, Eccles M, et al. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res 2005;5(1):25. DOI: 10.1186/1472-6963-5-25.
  7. Kavanagh BP. The GRADE system for rating clinical guidelines. PLoS Med 2009;6(9):e1000094. DOI: 10.1371/journal.pmed.1000094.
  8. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924–926. DOI: 10.1136/bmj.39489.470347.AD.
  9. Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines. Gac Sanit 2018;32(2):167.e1–167.e10. DOI: 10.1016/j.gaceta.2017.03.008.
  10. Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines. BMJ 2016;353:i2089. DOI: 10.1136/bmj.i2089.
  11. Boone DC, Federle M, Billiar TR, et al. Evolution of management of major hepatic trauma: identification of patterns of injury. J Trauma 1995;39(2):344–350. DOI: 10.1097/00005373-199508000-00026.
  12. Kozar RA, Moore FA, Moore EE, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma 2009;67(6):1144–1148.; discussion 8–9 10.1097/TA.0b013e3181ba361f.
  13. Kozar RA, Feliciano DV, Moore EE, et al. Western Trauma Association/critical decisions in trauma: operative management of adult blunt hepatic trauma. J Trauma 2011;71(1):1–5. DOI: 10.1097/TA.0b013e318220b192.
  14. Como JJ, Bokhari F, Chiu WC, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 2010;68(3):721–733. DOI: 10.1097/TA.0b013e3181cf7d07.
  15. Hwang K, Kwon J, Cho J, et al. Implementation of trauma center and massive transfusion protocol improves outcomes for major trauma patients: a study at a single institution in Korea. World J Surg 2018;42(7):2067–2075. DOI: 10.1007/s00268-017-4441-5.
  16. Meyer DE, Vincent LE, Fox EE, et al. Every minute counts: time to delivery of initial massive transfusion cooler and its impact on mortality. J Trauma Acute Care Surg 2017;83(1):19–24. DOI: 10.1097/TA.0000000000001531.
  17. Prat NJ, Meyer AD, Ingalls NK, et al. Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties. J Trauma Acute Care Surg 2017;83(3):373–380. DOI: 10.1097/TA.0000000000001568.
  18. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38(3):323–324. DOI: 10.1097/00005373-199503000-00001.
  19. Perumean JC, Martinez M, Neal R, et al. Low-grade blunt hepatic injury and benefits of intensive care unit monitoring. Am J Surg 2017;214(6):1188–1192. DOI: 10.1016/j.amjsurg.2017.09.003.
  20. Brenner M, Inaba K, Aiolfi A, et al. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the American Association for the Surgery of Trauma's Aortic Occlusion in resuscitation for trauma and acute care surgery registry. J Am Coll Surg 2018;226(5):730–740. DOI: 10.1016/j.jamcollsurg.2018.01.044.
  21. Pringle J. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908;48(4):541–549. DOI: 10.1097/00000658-190810000- 00005.
  22. Fingerhut A, Trunkey D. Surgical management of liver injuries in adults—current indications and pitfalls of operative and non-operative policies: a review. Eur J Surg 2000;166(9):676–686. DOI: 10.1080/110241500750008411.
  23. Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent pringle maneuver in hepatectomy for liver tumors. Arch Surg 1999;134(5):533–539. DOI: 10.1001/archsurg.134.5.533.
  24. Ball CG, Wyrzykowski AD, Nicholas JM, et al. A decade's experience with balloon catheter tamponade for the emergency control of hemorrhage. J Trauma 2011;70(2):330–333. DOI: 10.1097/TA.0b013e318203285c.
  25. Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016;80(3):529–537. DOI: 10.1097/TA.0000000000000942.
  26. Arora BK, Arora R, Arora A. Pedicled omentum hepatorrhaphy in blunt hepatic trauma. Int Surg J 2017;4(9):3038–3042. DOI: 10.18203/2349-2902.isj20173883.
  27. Ribeiro Jr MA, Medrado MB, Rosa OM, et al. Liver transplantation after severe hepatic trauma: current indications and results. Arq Bras Cir Dig 2015;28(4):286–289. DOI: 10.1590/s0102-6720201500040017.
  28. Patrono D, Brunati A, Romagnoli R, et al. Liver transplantation after severe hepatic trauma: a sustainable practice. A single-center experience and review of the literature. Clin Transplant 2013;27(4):E528–E537. DOI: 10.1111/ctr.12192.
  29. Boese CK, Hackl M, Muller LP, et al. Nonoperative management of blunt hepatic trauma: a systematic review. J Trauma Acute Care Surg 2015;79(4):654–660. DOI: 10.1097/TA.0000000000000814.
  30. Cirocchi R, Trastulli S, Pressi E, et al. Non-operative management versus operative management in high-grade blunt hepatic injury. Cochrane Database Syst Rev 2015;8:CD010989. DOI: 10.1002/14651858.CD010989.pub2.
  31. Coccolini F, Catena F, Moore EE, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016;11:50. DOI: 10.1186/s13017-016-0105-2.
  32. Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 1995;221(6):744–753.; discussion 53–55 10.1097/00000658-199506000-00013.
  33. Kutcher ME, Weis JJ, Siada SS, et al. The role of computed tomographic scan in ongoing triage of operative hepatic trauma: a Western Trauma Association multicenter retrospective study. J Trauma Acute Care Surg 2015;79(6):951–956.; discussion 6 10.1097/TA.0000000000000692.
  34. Melloul E, Denys A, Demartines N. Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: a systematic review and critical appraisal of the literature. J Trauma Acute Care Surg 2015;79(3):468–474. DOI: 10.1097/TA.0000000000000724.
  35. Stassen NA, Bhullar I, Cheng JD, et al. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73(5 Suppl 4):S288–S293. DOI: 10.1097/TA.0b013e318270160d.
  36. Anand RJ, Ferrada PA, Darwin PE, et al. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma 2011;71(2):480–485. DOI: 10.1097/TA.0b013e3181efc270.
  37. Asensio JA, Petrone P, Garcia-Nunez L, et al. Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV–V: a prospective study. Scand J Surg 2007;96(3):214–220. DOI: 10.1177/145749690709600306.
  38. Asensio JA, Roldan G, Petrone P, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma 2003;54(4):647–653.; discussion 53–54 10.1097/01.TA.0000054647.59217.BB.
  39. Notrica DM, Eubanks 3rd JW, Tuggle DW, et al. Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg 2015;79(4):683–693. DOI: 10.1097/TA.0000000000000808.
  40. Peitzman AB, Marsh JW. Advanced operative techniques in the management of complex liver injury. J Trauma Acute Care Surg 2012;73(3):765–770. DOI: 10.1097/TA.0b013e318265cef5.
  41. Schnuriger B, Talving P, Barbarino R, et al. Current practice and the role of the CT in the management of penetrating liver injuries at a level I trauma center. J Emerg Trauma Shock 2011;4(1):53–57. DOI: 10.4103/0974-2700.76838.
  42. Ward J, Alarcon L, Peitzman AB. Management of blunt liver injury: what is new? Eur J Trauma Emerg Surg 2015;41(3):229–237. DOI: 10.1007/s00068-015-0521-0.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.