Pre-existing liver disease in the trauma patient.

Interest in the importance of pre-existing disease as an outcome predictor in trauma patients has begun to receive attention only recently. Data relating specifically to pre-existing liver disease remains scant. With an overall prevalence of 0.5% among all trauma patients, pre-existing liver disease has been shown to increase mean duration of hospital stay by up to 36% and mortality by a factor of five (Table 9). This data appears to support the recommendation of the American College of Surgeons Committee on Trauma in their most recent bulletin, "Resources for the Optimal Care of the Injured Patient," that a history of cirrhosis in an injured patient should alert prehospital providers to contact medical control and consider transport to a trauma center. The majority of the data on the pathophysiologic and clinical responses and management of the patient with pre-existing liver disease have been extrapolated from literature on liver disease in the surgical patient and in sepsis. Few specific data on the management of the trauma patient with pre-existing liver disease and its effects on morbidity and mortality are available. We hope this review stimulates further research, particularly on the pathophysiologic and clinical responses to trauma exhibited by patients with liver disease.