Adults with isolated low-grade blunt liver injury rarely require intervention: A retrospective study

Abstract

Background: Nonoperative management of blunt liver injury has traditionally consisted of admission for at least 24-72 hours for observation. However, the necessity of admission to a monitored unit and serial hemoglobin levels in stable patients is questionable. The aim of this study was to evaluate the rate of hospital-based intervention for adults with low-grade blunt liver injury and to identify variables associated with need for hospital-based intervention.

Methods: A retrospective cohort study of adult patients with low-grade blunt liver injury in the American College of Surgeons Trauma Quality Improvement Program registry from 2019 to 2022 was performed. The primary outcome was percentage of patients who received hospital-based intervention for low-grade blunt liver injury. A secondary outcome was analysis of variables associated with need for intervention. A nomogram for individual risk of intervention was created from the best-performing logistic regression model.

Results: Of 4,498 patients who met criteria for analysis, 60 (1.33%) required intervention for low-grade blunt liver injury. On multivariate analysis, older age (odds ratio 1.02, 95% confidence interval 1.00-1.03, P = .02), tachycardia, (odds ratio 2.18, 95% confidence interval 1.26-3.72, P < .01), and hypotension (odds ratio 13.88, 95% confidence interval 6.55-28.28, P < .01) were associated with undergoing intervention. The nomogram showed that patients who are hemodynamically stable on arrival and <51 years old have <1% probability of undergoing intervention.

Conclusions: Adult patients with isolated low-grade blunt liver injury have low rates of intervention. Younger patients who are hemodynamically stable on arrival may be able to be safely discharged to home after a short observation.