Analysis Risk Factors Affecting Of Operation And Prognosis For Liver Trauma In Children

Objective:To analyze the risk factors affecting the operation and prognosis of liver trauma in children,and provide reference for clinical diagnosis and treatnent of liver trauma in children.Methods:257 patients with liver trauma from July 2003 to December 2018 in Children's Hospital of Soochow University were collected.217 of them were enrolled.All of them are blunt liver trauma.They were divided into operation group and non-operation group according to the treatment methods.Death group and survival group were divided according to the prognosis.The factors such as gender,age,injury mechanism,shock at admission,WBC,HB,PLT,ALT,AST,LDH,AAST grade,ISS grade,liver lobe injury,combined injury,blood transfusion volume are analyzed and compared between the two groups.Then using single factor and multifactor Logistic regression analysis to get the independent risk factors of operation and death.Finally,the ROC curve 1s used to analyze the risk factors to predict the effect of surgery and death.Results:There are 205 cases of non-operation treatment and 12 cases of operation treatment.The results of ?2 test or Mann-Whitney U test showed that there were significant differences in shock at admission,HB,ALT,AST and AAST grade between the group(p<0.05).AAST grade and HB are related to operation.Multivariate Logistic regression analysis showed that shock at admission(OR=7.009,p=0.022)and AAST grade(OR=2.056,p=0.022)are the independent risk factors for operation.The AUC of shock is 0.834(p<0.001),AAST grade is 0.796(p=0.001),and the optimum threshold is ?grade.The sensitivity and specificity were 0.83 and 0.61,respectively.There are 206 survivors and 11 deaths in this study.There are significant differences in injury mechanism,time from injury to admission,shock at admission,combine with craniocerebral injury,spleen injury,skeletal muscle injury,AAST grade,ISS grade,operation,blood transfusion volume and HB between survivors and deaths by ?2 test or Mann-Whitney U test(p<0.05).Logistic regression analysis showed that the time from injury to admission,shock at admission,operation,blood transfusion volume,ISS grade,combined craniocerebral injury,spleen injury,skeletal muscle injury,WBC and HB are related to the death.The results of Logistic regression analysis showed that shock at admission(OR=26.318,p=0.002)is the independent risk factor for death.The AUC is 0.916(p<0.001).Conclusion:(1)Shock at admission and AAST grade are the risk factors for operation,which have a good value in guiding the treatment of liver trauma in children.(2)Shock at admission is the risk factor of death,which is significant in predicting the prognosis of liver trauma in children.(3)Strengthen the care of children,avoid the occurrence of accidental injuries,actively correct shock and strengthen pre-hospital emergency management,so as to reduce the occurrence of accidents and mortality.