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http://dx.doi.org/10.20408/jti.2021.0009

Validity of the scoring system for traumatic liver injury: a generalized estimating equation analysis  

Lee, Kangho (Department of Trauma and Surgical Critical Care, Pusan National University Hospital)
Ryu, Dongyeon (Department of Trauma and Surgical Critical Care, Pusan National University Hospital)
Kim, Hohyun (Department of Trauma and Surgical Critical Care, Pusan National University Hospital)
Jeon, Chang Ho (Department of Diagnostic Radiology, The Catholic University of Korea Eunpyeong St. Mary's Hospital)
Kim, Jae Hun (Department of Trauma and Surgical Critical Care, Pusan National University Hospital)
Park, Chan Yong (Department of Trauma Surgery, Seoul National University Hospital)
Yeom, Seok Ran (Biomedical Research Institute, Pusan National University Hospital)
Publication Information
Journal of Trauma and Injury / v.35, no.1, 2022 , pp. 25-33 More about this Journal
Abstract
Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0-1 (age and Injury Severity Score) or 0-3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0-11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018-1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.
Keywords
Wounds and injuries; Liver; Trauma severity indices; Prognosis;
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1 Arumugam S, Al-Hassani A, El-Menyar A, et al. Frequency, causes and pattern of abdominal trauma: a 4-year descriptive analysis. J Emerg Trauma Shock 2015;8:193-8.   DOI
2 She WH, Cheung TT, Dai WC, et al. Outcome analysis of management of liver trauma: a 10-year experience at a trauma center. World J Hepatol 2016;8:644-8.   DOI
3 Virdis F, Reccia I, Di Saverio S, et al. Clinical outcomes of primary arterial embolization in severe hepatic trauma: a systematic review. Diagn Interv Imaging 2019;100:65-75.   DOI
4 Cimbanassi S, Chiara O, Leppaniemi A, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: results from an International Consensus Conference. J Trauma Acute Care Surg 2018;84:517-31.   DOI
5 Plessier A, Denninger MH, Consigny Y, et al. Coagulation disorders in patients with cirrhosis and severe sepsis. Liver Int 2003;23:440-8.   DOI
6 Kelley KC, Dammann K, Alers A, Zanders TB, Bendas C, Stawicki SP. Resuscitation endpoints in traumatic shock: a focused review with emphasis on point-of-care approaches. In: Stawicki SP, Swaroop M, editors. Clinical management of shock: the science and art of physiological restoration. London: Intech Open; 2020.
7 Bertens KA, Vogt KN, Hernandez-Alejandro R, Gray DK. Non-operative management of blunt hepatic trauma: does angioembolization have a major impact? Eur J Trauma Emerg Surg 2015;41:81-6.   DOI
8 Costa G, Tierno SM, Tomassini F, et al. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir 2010;81: 95-102.
9 Brillantino A, Iacobellis F, Festa P, et al. Non-operative management of blunt liver trauma: safety, efficacy and complications of a standardized treatment protocol. Bull Emerg Trauma 2019;7:49-54.   DOI
10 Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg 2003;138:475-80.   DOI
11 Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989;29:623-9.   DOI
12 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):S288-93.   DOI
13 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.   DOI
14 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: 187-96.   DOI
15 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;36:813-8.   DOI
16 Moseley RH. Sepsis and cholestasis. Clin Liver Dis 2004;8:83-94.   DOI
17 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;43:1347-54.   DOI
18 Child CG. The liver and portal hypertension. Major problems in clinical surgery. Vol. 1. Philadelphia: Saunders; 1964.
19 Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics 1988; 44:1049-60.   DOI
20 Kim HH, Kim JH, Park CY, Cho HM. Scoring system for traumatic liver injury (SSTLI) in polytraumatic patients: a predictor of mortality. Eur J Trauma Emerg Surg 2015;41: 375-85.   DOI
21 Corneille MG, Nicholson S, Richa J, et al. Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. J Trauma 2011; 71:6-11.
22 Smith J, Caldwell E, D'Amours S, Jalaludin B, Sugrue M. Abdominal trauma: a disease in evolution. ANZ J Surg 2005; 75:790-4.   DOI
23 Talving P, Lustenberger T, Okoye OT, et al. The impact of liver cirrhosis on outcomes in trauma patients: a prospective study. J Trauma Acute Care Surg 2013;75:699-703.   DOI
24 Ferreira AM, Sakr Y. Organ dysfunction: general approach, epidemiology, and organ failure scores. Semin Respir Crit Care Med 2011;32:543-51.   DOI