Evidence map›Paper›PMID 42059943›Full record

ArticleLangenbeck's archives of surgery2026

Contemporary management pathways in liver trauma: predominant and successful use of non-operative strategies at a high-volume tertiary center.

Bruno Cirillo, Gioia Brachini, Roberto Cirocchi, Chiara Tranfaglia, Andrea Mingoli, Lina De Paola, Eleonora Lori, Salvatore Sorrenti, Antonio Pesce

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Article in Langenbeck's archives of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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9 authors.

Bruno CirilloDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Gioia BrachiniDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Roberto CirocchiDepartment of Surgery, General Surgery, University of Perugia, Perugia, Italy.
Chiara TranfagliaDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Andrea MingoliDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Lina De PaolaDepartment of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy. Lina.depaola@uniroma1.it.
Eleonora LoriDepartment of Surgery, Sapienza University of Rome, Rome, Italy.
Salvatore SorrentiDepartment of Wellbeing, Health and Environmental Sustainability, Sapienza University of Rome, Rome, Italy.
Antonio PesceDepartment of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Lagosanto, Ferrara, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNon-operative management (NOM) has become the default for haemodynamically stable liver trauma, yet pathway-level performance and bedside predictors of mortality warrant contemporary appraisal in University trauma centres.

methodsWe conducted a single-centre retrospective cohort study of consecutive adults (≥ 18 years) with blunt or penetrating hepatic injury managed within a protocolised, physiology- and CT-guided pathway (1 Jan 2018–30 Apr 2025). The primary endpoint was in-hospital mortality. Secondary endpoints included NOM failure, liver-specific complications, and era-level outcomes (2018–2021 vs. 2022–2025). Independent predictors of mortality were assessed with multivariable logistic regression; discrimination was evaluated by ROC analysis.

resultsAmong 350 patients, NOM was initiated in 304 (86.9%); delayed conversion to laparotomy occurred in 15/304 (4.9%), including 5 after prior angioembolisation (IR in 32/350; 9.1%). Overall in-hospital mortality was 14.9% (52/350) and clustered in patients with physiological compromise and high global injury burden. Definitive management stratified patients into NOM and operative management cohorts, with lower mortality after definitive NOM than after operative management. In multivariable analysis, Shock Index (OR 2.71 per unit; p = 0.022), ISS (OR 1.05 per point; p < 0.001) and lactate (OR 1.17 per mmol/L; p = 0.031) independently increased the odds of death, whereas GCS was protective (OR 0.89 per point; p = 0.002); AAST high grade and era were not independently associated. Model discrimination was excellent (AUC 0.87; Youden-optimal sensitivity 0.92, specificity 0.74); Shock Index alone achieved AUC 0.75, while AAST grade provided modest separation (AUC 0.608). Secondary transfers (40.3%) incurred no survival penalty. Era comparison showed reduced operative exposure (21.5%→12.3%, OR 0.51, p = 0.024) and mortality (18.5%→10.3%, OR 0.51, p = 0.035) after formalising the pathway.

conclusionsIn a university trauma centre, a protocolised physiology- and CT-guided pathway delivered high NOM utilisation with low failure and era-level gains. Short-term mortality was driven predominantly by physiology and global injury severity rather than anatomical grade. Multicentre prospective and implementation studies are warranted to mitigate residual biases and validate pragmatic bedside risk composites.

Indexed as

Abdominal InjuriesCritical PathwaysLiverWounds, NonpenetratingWounds, PenetratingAdultFemaleHospital MortalityHumansInjury Severity ScoreMaleMiddle AgedRetrospective StudiesTertiary Care CentersAngioembolisationEra analysisInjury Severity ScoreLiver traumaNon-operative managementROC analysisShock IndexUniversity trauma centre

Identifiers

PMID42059943
PMCPMC13275601

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.