Development:
(1) based on 36 consecutive patients undergoing surgery for liver trauma between 1984 and 1993 at the Osaka Police Hospital in Japan
(2) 15 patients had blunt trauma, 6 had gunshot wounds, and 15 had stab wounds
(3) based on multivariate analysis
risk of death =
= 0.5830 - (0.03656 * (Glasgow coma score)) + (0.009954 * (postoperative BUN in mg/dL)) + (0.05494 * (number of associated organ injuries)) + (0.0001175 * (preoperative ALT in IU/L)) - (0.002967 * (preoperative systolic blood pressure in mm Hg))
where:
• a risk of 1 indicates death, a risk of 0 indicates survival
• values for the Glasgow coma score range from 3 to 15
• ALT = SGPT = alanine aminotransferase
risk of hemorrhagic death =
= 0.1787 - (0.0001755 * (preoperative ALT in IU/L)) - (0.03228 * (preoperative base excess in mEq/L)) + (0.01272 * (preoperative platelet count as 10^4/µL))
where:
• a risk of 1 indicates hemorrhagic death, a risk of 0 indicates survival
• platelet count of 250,000 per µL would be 25 *10^4/µL, with 25 used in the equation
risk of death from sepsis =
= 0.4878 - (0.004259 * (preoperative systolic blood pressure in mm Hg)) + (0.212 * (intestinal injury score)
where:
• a risk of 1 indicates septic death, a risk of 0 indicates survival
• intestinal injury score = 0 if intestinal injury absent, 1 if present
Limitations:
• ALT results may vary with different methods and instruments. However, considering the factor used to multiply it (0.0001755), this variation would probably have limited impact in the risk.
• Improvements in management would tend to improve prognosis.
• Emergence of antibiotic resistant bacteria would worsen prognosis in sepsis.
