Department of Surgery, National Yang-Ming Medical University Hospital, I-lan, Taiwan, ROC.
J Chin Med Assoc. 2013 Oct;76(10):576-82. doi: 10.1016/j.jcma.2013.06.004. Epub 2013 Jul 24.
Liver trauma is the main cause of death arising from blunt abdominal injury. Nonoperative management (NOM) has been advocated to be a safe option for stable patients who have suffered liver trauma. This study used a population-based dataset to illustrate the incidence of liver trauma, its various causes and treatment, and outcomes.
Information about all patients with any ICD-9-CM coded as liver injury was retrieved as part of a claims dataset for the years 2007 and 2008 from the database maintained in the Bureau of National Health Insurance in Taiwan. Thereafter, statistical analyses were conducted to discover the incidence, mortality rate, percentage of patients receiving NOM, and the association between variables such as age, gender, injury mechanisms, associated injuries, and outcome.
A total of 3196 liver trauma patients were admitted in 2007 and 2008, resulting in 264 deaths. The incidence rate is 13.9/100,000 population. The highest incidence rate was in the age 15-24 years group, 25.9/100,000 population; the highest mortality rate was in the age 75-84 years group, 2.1/100,000 population. Additionally, rural residents possessed a higher incidence and mortality rate than urban residents (15.9/100,000 population vs. 12.2/100,000 population and 1.4/100,000 population vs. 1.0/100,000 population). By using logistic regression, the mortality rate was significantly higher in the groups with patients aged >64 years, renal failure or liver cirrhosis, with head or chest, or other abdominal injury. If a patient received a hepatic or abdominal operation, this was retrospectively found to be associated with increased mortality risk (4.731 times, p < 0.001 and 4.311 times, p < 0.001, respectively); however, the characteristics of the treating hospitals did not influence the mortality rate. Patients whose monthly income was >US$660 were found to have a higher mortality risk (2.209 times, p < 0.001).
The overall incidence rate of liver trauma was higher in the younger age group and in rural residents. A higher risk of mortality was found in the age > 64 years group, pedestrians hit in motor-vehicle accidents, renal failure or liver cirrhosis, with head or chest, or other abdominal injury.
肝脏创伤是腹部钝性伤导致死亡的主要原因。对于稳定型肝外伤患者，非手术治疗（NOM）已被提倡为一种安全的选择。本研究使用基于人群的数据集来说明肝脏创伤的发生率、其各种原因和治疗方法以及结果。
从台湾国民健康保险局数据库中检索了 2007 年和 2008 年所有 ICD-9-CM 编码为肝脏损伤的患者信息。此后，进行了统计分析以发现发病率、死亡率、接受 NOM 的患者比例以及年龄、性别、损伤机制、合并伤和结果等变量之间的关系。
2007 年和 2008 年共收治 3196 例肝外伤患者，死亡 264 例。发病率为 13.9/100,000 人。发病率最高的年龄组为 15-24 岁，为 25.9/100,000 人；死亡率最高的年龄组为 75-84 岁，为 2.1/100,000 人。此外，农村居民的发病率和死亡率均高于城市居民（15.9/100,000 人比 12.2/100,000 人，1.4/100,000 人比 1.0/100,000 人）。通过逻辑回归，发现年龄>64 岁、肾衰竭或肝硬化、头部或胸部或其他腹部损伤的患者死亡率显著更高。如果患者接受肝脏或腹部手术，这被发现与增加的死亡率风险相关（分别为 4.731 倍，p<0.001 和 4.311 倍，p<0.001）；然而，治疗医院的特征并不影响死亡率。发现月收入>660 美元的患者死亡率更高（2.209 倍，p<0.001）。
肝脏创伤的总发病率在年轻人群和农村居民中较高。发现年龄>64 岁、行人在机动车事故中受伤、肾衰竭或肝硬化、头部或胸部或其他腹部损伤的患者死亡率风险更高。
