Prichayudh et al identified predictors for surgery in a patient with hepatic trauma. These patients require more aggressive management. The authors are from Chulalongkorn University in Bangkok.

Patient selection: liver trauma


Predictors for undergoing surgery:

(1) Glasgow coma score <= 12

(2) penetrating mechanism

(3) heart rate > 100 beats per minute (tachycardia)

(4) systolic blood pressure <= 90 mm Hg


Predictors for damage control surgery (perihepatic packing and temporary abdominal closure):

(1) Grade 4 or 5 hepatic trauma, including injuries to the juxtahepatic inferior vena cava

(2) heart rate > 100 beats per minute (tachycardia)

(3) blunt mechanism


Indications for damage control surgery:

(1) hemodynamic instability with failure to control bleeding by simpler methods

(2) hypothermia

(3) acidosis

(4) coagulopathy

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