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Background Our institution became a Major Trauma Centre (MTC) in 2012, currently serving a population of 2.3 million. This study aims to evaluate the trends in blunt hepatic trauma (BHT) and the changes in management strategy over time (pre- and post- MTC era). Methods This was a single-centre, retrospective cohort study. Data were obtained from the Trauma Audit and Research Network (TARN) database across a 20-year period (2000–2020). Results 209 patients presented with BHT: 31 in 2000–2011 and 178 in 2012–2020. The median age was 35.6 and M:F ratio was 2.8:1. Road traffic accidents (RTAs) were the most common mechanism (n=124, 59.3%), followed by fall from height (n=44, 21.1%). Patients had a median ISS of 25 (range 4–75). 109 patients were managed conservatively (52.5%), with 10 of these patients having angioembolisation. Although 100 patients (47.8%) underwent operative management, only 7 patients underwent liver surgeries such as liver laceration repair (n=7, 3.3%) or resection (n=2, 1%). Mortality rate was 13.8% (n=44) in the conservative group and 21% in the operative group. The overall mortality was 16.7% (n=35). The subgroups analyses revealed no significant difference in mortality for patients managed non-operatively. Conclusions BHT patients frequently present as a polytrauma. Only 3.3% required a laparotomy and intervention to the liver parenchyma. The establishment of the MTC was associated with a significant increase in BHT presentations. The proportion of conservatively managed patients was similar pre- and post-MTC eras. The mortality rates were not significantly different.

Background In the context of penetrating liver trauma (PLT), the liver is the second most commonly injured intra-abdominal organ. Our institution has served as a regional Major Trauma Centre (MTC) since 2012. This study aims to review trends in PLT presenting to our institution and how management has changed over time. Methods This was a single-centre, retrospective cohort study using data obtained from the Trauma Audit and Research Network (TARN) database across a 20-year period (2000–2020). Results 77 patients presented with PLT; 21 prior to MTC status in 2012 and 56 after. Median age was 26.8, M:F ratio was 6.9:1 and median Injury severity score (ISS) was 14. Stabbing was the most common mechanism of injury (n=53, 68.8%), followed by shooting (n=22, 28.6%). 24 patients were managed conservatively (31.2%) and 5 patients underwent angioembolisation. Prior to becoming an MTC in 2012, 19% of patients (4/21) were managed non-operatively and this increased to 50% (28/56) when the MTC was established (P < 0.05). Understandably, there was a significant increase in injury severity in the post-MTC era (mean ISS 11.75 with SD=2.8 vs 17.9 with SD=2.1). The mortality in the conservative group was 20.7% (n=6) vs 8.3% in the operative group. Overall mortality from PLT was 11.7%. Conclusion There was a statistically significant increase in non-operative management of PLT since the MTC was established, there has been no observed increase in mortality during this period.

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores ( 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.