Impact of trauma teams on high grade liver injury care: a two-decade propensity score approach study in Taiwan

Abstract

High-grade liver laceration is a common injury with bleeding as the main cause of death. Timely resuscitation and hemostasis are keys to the successful management. The impact of in-hospital trauma system on the quality of resuscitation and management in patients with traumatic high-grade liver laceration, however, was rarely reported. We retrospectively reviewed the impact of team-based approach on the quality and outcomes of high-grade traumatic liver laceration in our hospital. Patients with traumatic liver laceration between 2002 and 2020 were enrolled in this retrospective study. Inverse probability of treatment weighting (IPTW)-adjusted analysis using the propensity score were performed. Outcomes before the trauma team establishment (PTTE) and after the trauma team establishment (TTE) were compared. A total of 270 patients with liver trauma were included. After IPTW adjustment, interval between emergency department arrival and managements was shortened in the TTE group with a median of 11 min (p < 0.001) and 28 min (p < 0.001) in blood test reports and duration to CT scan, respectively. Duration to hemostatic treatments in the TTE group was also shorter by a median of 94 min in patients receiving embolization (p = 0.012) and 50 min in those undergoing surgery (p = 0.021). The TTE group had longer ICU-free days to day 28 (0.0 vs. 19.0 days, p = 0.010). In our study, trauma team approach had a survival benefit for traumatic high-grade liver injury patients with 65% reduction of risk of death within 72 h (Odds ratio (OR) = 0.35, 95% CI = 0.14-0.86) and 55% reduction of risk of in-hospital mortality (OR = 0.45, 95% CI = 0.23-0.87). A team-based approach might contribute to the survival benefit in patients with traumatic high-grade liver laceration by facilitating patient transfer from outside the hospital, through the diagnostic examination, and to the definitive hemostatic procedures.

Figure 1

Diagram of study stratification according to propensity score weighting.

Figure 2

A range of intervals between ED arrival and managements over time. Duration to blood test reports (left upper). Duration to CT scan (right upper). Duration to treatment (left lower). Median curves are depicted. Shaded vertical bars represent interquartile range. Massive transfusion (transfused more than 10 units) quality (percentage of RBC/FFP ratio within 0.5–1.5) over time is shown in right lower panel.

Figure 3

Chronological changes in transfusion amount. Median of resuscitation volume over time. Resuscitation volumes are further stratified by managements. All patients (left upper). NOM without TAE group (right upper). NOM with TAE (right middle). OM (left lower). NOM (right lower).