Skip to main content
SpringerLink
Log in

Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to examine prognostic factors in polytraumatic patients with liver injury and to develop a scoring system for traumatic liver injury (SSTLI) to predict mortality.

Methods

The medical records of 175 patients treated for traumatic liver injury from July 2009 to April 2013 were reviewed. The primary outcome variable was hospital mortality. All risk factors were analyzed by multivariate logistic regression analysis. The SSTLI was created based on the predictive power of each factor.

Results

Age, injury severity score (ISS), trauma and injury severity score, the shock index, and the volume of packed red blood cells transfused were strong predictors of mortality. We hypothesized that the SSTLI would use five clinical measures (total bilirubin, prothrombin time, serum creatinine, age, and ISS). Each measure was scored 0–1 (age and ISS) or 0–3 (total bilirubin, prothrombin time, and creatinine), with 3 indicating the most severe derangement. The receiver-operating characteristic curve of the SSTLI was significant at post-traumatic days 0, 1, 3, and 5 [area under the curve (AUC), 0.830; AUC, 0.912; AUC, 0.941; and AUC, 0.930, respectively]. A value of 5 points was the threshold for reliability dividing low-risk (<5) from high-risk (≥5) patients.

Conclusions

The SSTLI may be available to predict mortality in polytraumatic patients with liver injury, although external validation is needed before widespread implementation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Badger SA, Barclay R, Campbell P, Mole DJ, Diamond T. Management of liver trauma. World J Surg. 2009;33(12):2522–37. doi:10.1007/s00268-009-0215-z.

    Article  CAS  PubMed  Google Scholar 

  2. Ozogul B, Kisaoglu A, Aydinli B, Ozturk G, Bayramoglu A, Saritemur M, et al. Non-operative management (NOM) of blunt hepatic trauma: 80 cases. Ulusal travma ve acil cerrahi dergisi =Turkish J Trauma Emerg Surg : TJTES. 2014;20(2):97–100. doi:10.5505/tjtes.2014.20737.

    Article  Google Scholar 

  3. Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries. Am J Surg. 1995;169(4):442–54.

    Article  CAS  PubMed  Google Scholar 

  4. Feliciano DV, Rozycki GS. Hepatic trauma. Scand J Surg. 2002;91(1):72–9.

    CAS  PubMed  Google Scholar 

  5. Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, 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):S288–93. doi:10.1097/TA.0b013e318270160d.

    Article  PubMed  Google Scholar 

  6. Parks RW, Chrysos E, Diamond T. Management of liver trauma. Br J Surg. 1999;86(9):1121–35. doi:10.1046/j.1365-2168.1999.01210.x.

    Article  CAS  PubMed  Google Scholar 

  7. Gourgiotis S, Vougas V, Germanos S, Dimopoulos N, Bolanis I, Drakopoulos S, et al. Operative and nonoperative management of blunt hepatic trauma in adults: a single-center report. J Hepato-Biliary-Pancreat Surg. 2007;14(4):387–91. doi:10.1007/s00534-006-1177-2.

    Article  Google Scholar 

  8. Kozar RA, McNutt MK. Management of adult blunt hepatic trauma. Curr Opin Crit Care. 2010;16(6):596–601. doi:10.1097/MCC.0b013e32833f5cd5.

    Article  PubMed  Google Scholar 

  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Apache II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.

    Article  CAS  PubMed  Google Scholar 

  10. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.

    Article  CAS  PubMed  Google Scholar 

  11. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623–9.

    Article  CAS  PubMed  Google Scholar 

  12. Kimura A, Chadbunchachai W, Nakahara S. Modification of the trauma and injury severity score (TRISS) method provides better survival prediction in Asian blunt trauma victims. World J Surg. 2012;36(4):813–8. doi:10.1007/s00268-012-1498-z.

    Article  PubMed  Google Scholar 

  13. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma score and the injury severity score. J Trauma. 1987;27(4):370–8.

    Article  CAS  PubMed  Google Scholar 

  14. Champion HR, Sacco WJ, Copes WS. Injury severity scoring again. J trauma. 1995;38(1):94–5.

    Article  CAS  PubMed  Google Scholar 

  15. Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44(4):1049–60.

    Article  CAS  PubMed  Google Scholar 

  16. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4.

    Article  CAS  PubMed  Google Scholar 

  17. Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma. 1996;41(3):380–6; discussion 6-8.

    Article  CAS  PubMed  Google Scholar 

  18. West TA, Rivara FP, Cummings P, Jurkovich GJ, Maier RV. Harborview assessment for risk of mortality: an improved measure of injury severity on the basis of ICD-9-CM. J Trauma. 2000;49(3):530–40; discussion 40–1.

    Article  CAS  PubMed  Google Scholar 

  19. Talving P, Lustenberger T, Okoye OT, Lam L, Smith JA, Inaba K, et al. The impact of liver cirrhosis on outcomes in trauma patients: a prospective study. J Trauma Acute Care Surg. 2013;75(4):699–703. doi:10.1097/TA.0b013e31829a2c19.

    Article  PubMed  Google Scholar 

  20. Corneille MG, Nicholson S, Richa J, Son C, Michalek J, Wolf SE, et al. Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. J Trauma. 2011;71(1):6–11. doi:10.1097/TA.0b013e31822311c5.

    Article  PubMed  Google Scholar 

  21. Seamon MJ, Franco MJ, Stawicki SP, Smith BP, Kulp H, Goldberg AJ, et al. Do chronic liver disease scoring systems predict outcomes in trauma patients with liver disease? a comparison of MELD and CTP. J Trauma. 2010;69(3):568–73. doi:10.1097/TA.0b013e3181ec0867.

    Article  PubMed  Google Scholar 

  22. Pachter HL, Feliciano DV. Complex hepatic injuries. Surg Clinics N. Am. 1996;76(4):763–82.

    Article  CAS  Google Scholar 

  23. Di Saverio S, Catena F, Filicori F, Ansaloni L, Coccolini F, Keutgen XM, 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):1347–54. doi:10.1016/j.injury.2012.01.003.

    Article  PubMed  Google Scholar 

  24. Chen RJ, Fang JF, Lin BC, Hsu YP, Kao JL, Chen MF. Factors determining operative mortality of grade V blunt hepatic trauma. J Trauma. 2000;49(5):886–91.

    Article  CAS  PubMed  Google Scholar 

  25. Tran DD, Cuesta MA, van Leeuwen PA, Nauta JJ, Wesdorp RI. Risk factors for multiple organ system failure and death in critically injured patients. Surgery. 1993;114(1):21–30.

    CAS  PubMed  Google Scholar 

  26. Moseley RH. Sepsis and cholestasis. Clin Liver Dis. 2004;8(1):83–94. doi:10.1016/S1089-3261(03)00134-X.

    Article  PubMed  Google Scholar 

  27. Plessier A, Denninger MH, Consigny Y, Pessione F, Francoz C, Durand F, et al. Coagulation disorders in patients with cirrhosis and severe sepsis. Liver Int : Off J Int Assoc Study Liver. 2003;23(6):440–8.

    Article  Google Scholar 

  28. Ferreira AM, Sakr Y. Organ dysfunction: general approach, epidemiology, and organ failure scores. Semin Respir Crit Care Med. 2011;32(5):543–51. doi:10.1055/s-0031-1287862.

    Article  PubMed  Google Scholar 

  29. Child CG. The liver and portal hypertension. Major problems in clinical surgery. vol. 1. Philadelphia: Saunders; 1964.

Download references

Acknowledgments

This study was supported by a clinical research grant from Pusan National University Hospital 2013.

Conflict of interest

No potential conflict of interest relevant to this article is reported. Ho Hyun Kim, Jae Hun Kim, Chan-Yong Park, and Hyun Min Cho declare that they have no conflict of interest.

Ethical standard

This project received research approval from the Research Ethics Board of the local university and was therefore performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea

    H. H. Kim, J. H. Kim, C.-Y. Park & H. M. Cho

  2. Chonnam National University Medical School, Gwangju, Korea

    H. H. Kim

Authors
  1. H. H. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C.-Y. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. M. Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. H. Kim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, H.H., Kim, J.H., Park, CY. et al. Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality. Eur J Trauma Emerg Surg 41, 375–385 (2015). https://doi.org/10.1007/s00068-014-0454-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-014-0454-z

Keywords

Search

Navigation