{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:09:03Z","timestamp":1789398543705,"version":"build-2803163510"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Scand J Trauma Resusc Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with severe liver injury may carry a high risk of complications with significant mortality. Non-operative management (NOM) is increasingly common for severe injuries and may be associated with lower morbidity when compared with surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the incidence of NOM for severe liver trauma (American Association for the Surgery of Trauma (AAST) Grade IV and V) and compare outcomes for NOM vs operative management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All patients admitted between 2012\u20132022 with severe liver trauma to Birmingham and Nottingham Major Trauma Centres (MTCs) were identified from a validated dataset. Outcomes were compared between those managed by surgery vs treated by NOM. Adjusted multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for surgical management, survival rates, and development of liver-specific complications (adjusting for age, sex, ISS, AAST grade, polytrauma).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 190 patients; median age 28\u00a0years (IQR 20\u201341); 134 (71%) were male. Median ISS was 27 (IQR 17\u201341). Overall mortality was 7% (14\/190). 122\/190 (64%) patients were managed initially by NOM, with only 8\/122 (7%) requiring subsequent surgery. Multivariable logistic regression models showed higher ISS, lower SBP on admission, Grade V injuries and penetrating trauma to be independent predictors for surgical treatment. 34\/190(18%) patients had liver-specific complications. There was no difference between NOM and operative management groups for 30-day mortality\u00a0(\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.145), but patients in the NOM group had shorter ICU (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and total lengths of stay (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to the operative group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this modern MTC setting, a high proportion of patients with severe liver trauma were managed by NOM with a low failure rate. Overall mortality rate was low, but liver-specific complications were common. These data support the evolution of traumatic liver injury management in the UK and favour NOM even in severe liver injuries where patient physiology allows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This study was approved by Nottingham University Hospital Clinical Audit Team (ID Reference 22-709C) and University Hospitals Birmingham NHS Foundation Trust Clinical Audit Registration and Management System (ID Reference CARMS 19146). Consent for participation in the study was not obtained as this was a large retrospective audit with anonymised data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13049-026-01576-7","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T06:32:39Z","timestamp":1772778759000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes following non-operative management for severe liver trauma: a UK multicentre observational study"],"prefix":"10.1186","volume":"34","author":[{"given":"Adam","family":"Brooks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Joyce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Gouveia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Burak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"LaValle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John-Joe","family":"Reilly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Adiamah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Diacon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Blackburn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Melia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kitchen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iver Anders","family":"Gaski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Gaarder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paal Aksel","family":"N\u00e6ss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Naumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"1576_CR1","doi-asserted-by":"crossref","unstructured":"Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12:40.","DOI":"10.1186\/s13017-017-0117-6"},{"key":"1576_CR2","doi-asserted-by":"crossref","unstructured":"Matthes G, Stengel D, Seifert J, Rademacher G, Mutze S, Ekkernkamp A. Blunt liver injuries in polytrauma: Results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg. 2003;27(10):1124\u201330.","DOI":"10.1007\/s00268-003-6981-0"},{"key":"1576_CR3","doi-asserted-by":"crossref","unstructured":"Brooks A, Reilly JJ, Hope C, Navarro A, Naess PA, Gaarder C. Evolution of non-operative management of liver trauma. Trauma Surg Acute Care Open. 2020;5(1):e000551.","DOI":"10.1136\/tsaco-2020-000551"},{"key":"1576_CR4","doi-asserted-by":"crossref","unstructured":"Gaski IA, Skattum J, Brooks A, Koyama T, Eken T, Naess PA, et al. Decreased mortality, laparotomy, and embolization rates for liver injuries during a 13-year period in a major Scandinavian trauma center. Trauma Surg Acute Care Open. 2018;3(1):e000205.","DOI":"10.1136\/tsaco-2018-000205"},{"key":"1576_CR5","doi-asserted-by":"crossref","unstructured":"Shrestha B, Holcomb JB, Camp EA, Del Junco DJ, Cotton BA, Albarado R, et al. Damage-control resuscitation increases successful nonoperative management rates and survival after severe blunt liver injury. J Trauma Acute Care Surg. 2015;78(2):336\u201341.","DOI":"10.1097\/TA.0000000000000514"},{"key":"1576_CR6","doi-asserted-by":"crossref","unstructured":"Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119\u201322.","DOI":"10.1097\/TA.0000000000002058"},{"key":"1576_CR7","doi-asserted-by":"crossref","unstructured":"Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32(12):911\u20135.","DOI":"10.1136\/emermed-2015-205265"},{"key":"1576_CR8","doi-asserted-by":"crossref","unstructured":"Barrie J, Jamdar S, Iniguez MF, Bouamra O, Jenks T, Lecky F, et al. Improved outcomes for hepatic trauma in England and Wales over a decade of trauma and hepatobiliary surgery centralisation. European J Trauma Emerg Surg. 2018;44(1):63\u201370.","DOI":"10.1007\/s00068-017-0765-y"},{"key":"1576_CR9","doi-asserted-by":"crossref","unstructured":"Tarchouli M, Elabsi M, Njoumi N, Essarghini M, Echarrab M, Chkoff MR. Liver trauma: What current management? Hepatobil Pancreatic Diseases Int. 2018;17(1):39\u201344.","DOI":"10.1016\/j.hbpd.2018.01.013"},{"key":"1576_CR10","doi-asserted-by":"crossref","unstructured":"Keizer AA, Arkenbosch JHC, Kong VY, Hoencamp R, Bruce JL, Smith MTD, et al. Blunt and Penetrating Liver Trauma have Similar Outcomes in the Modern Era. Scandinavian J Surg. 2021;110(2):208\u201313.","DOI":"10.1177\/1457496920921649"},{"key":"1576_CR11","doi-asserted-by":"crossref","unstructured":"Yoong S, Kothari R, Brooks A. Assessment of sensitivity of whole body CT for major trauma. Europ J Trauma Emerg Surg. 2019;45(3):489\u201392.","DOI":"10.1007\/s00068-018-0926-7"},{"key":"1576_CR12","doi-asserted-by":"crossref","unstructured":"Crebbin W, Beasley SW, Watters DAK. Clinical decision making: How surgeons do it. ANZ J Surg. 2013;83(6):422\u20138.","DOI":"10.1111\/ans.12180"},{"key":"1576_CR13","doi-asserted-by":"crossref","unstructured":"Kierkegaard P, Vale MD, Garrison S, Hollenbeck BK, Hollingsworth JM, Owen-Smith J. Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients\u2014A qualitative study. J Surg Oncol. 2020;121(3):561\u20139.","DOI":"10.1002\/jso.25819"},{"key":"1576_CR14","doi-asserted-by":"crossref","unstructured":"Sutton P, Hornby S, Vimalachandran D, McNally S. Instinct, intuition and surgical decision-making. The Bulletin of the Royal College of Surgeons of England. 2015;97(8):345\u20137.","DOI":"10.1308\/rcsbull.2015.345"},{"key":"1576_CR15","doi-asserted-by":"crossref","unstructured":"Pauley K, Flin R, Yule S, Youngson G. Surgeons\u2019 intraoperative decision making and risk management. Am J Surg. 2011;202(4):375\u201381.","DOI":"10.1016\/j.amjsurg.2010.11.009"},{"key":"1576_CR16","doi-asserted-by":"crossref","unstructured":"Ahmed N, Vernick JJ. Management of liver trauma in adults. J Emerg, Trauma Shock. 2011;4(1):114\u20139.","DOI":"10.4103\/0974-2700.76846"},{"key":"1576_CR17","doi-asserted-by":"crossref","unstructured":"Edalatpour A, Young BT, Brown LR, Tseng ES, Ladhani HA, Patel NJ, et al. Grade of injury, not initial management, is associated with unplanned interventions in liver injury. Injury. 2020;51(6):1301\u20135.","DOI":"10.1016\/j.injury.2020.03.043"},{"key":"1576_CR18","doi-asserted-by":"crossref","unstructured":"Diercks DB, Mehrotra A, Nazarian DJ, Promes SB, Decker WW, Fesmire FM. Clinical policy: Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Ann Emerg Med. 2011;57(4):387\u2013404.","DOI":"10.1016\/j.annemergmed.2011.01.013"},{"key":"1576_CR19","doi-asserted-by":"crossref","unstructured":"Colnaric JM, El Sibai RH, Bachir RH, El Sayed MJ. Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study. Medicine (United States). 2022;101(28):e29614.","DOI":"10.1097\/MD.0000000000029614"},{"key":"1576_CR20","doi-asserted-by":"crossref","unstructured":"Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15(1):24.","DOI":"10.1186\/s13017-020-00302-7"},{"issue":"5","key":"1576_CR21","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1097\/TA.0000000000004372","volume":"97","author":"PD Nguyen","year":"2024","unstructured":"Nguyen PD, Nahmias J, Aryan N, et al. Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: a WTA multicenter study. J Trauma Acute Care Surg. 2024;97(5):764\u20139.","journal-title":"J Trauma Acute Care Surg"},{"key":"1576_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2024.10.002","volume":"178","author":"PD Nguyen","year":"2025","unstructured":"Nguyen PD, Nahmias J, Aryan N, et al. Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: a Western Trauma Association multicenter study. Surgery. 2025;178:108909.","journal-title":"Surgery"},{"issue":"3","key":"1576_CR23","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1097\/TA.0000000000004509","volume":"98","author":"S Keihani","year":"2025","unstructured":"Keihani S, Tominaga GT, Matta R, et al. Kidney organ injury scaling: 2025 update. J Trauma Acute Care Surg. 2025;98(3):448\u201351.","journal-title":"J Trauma Acute Care Surg"},{"key":"1576_CR24","doi-asserted-by":"crossref","unstructured":"Rozycki GF, Sakran J V., Manukyan MC, Feliciano D V., Radisic A, You B, et al. Angioembolization May Improve Survival in Patients With Severe Hepatic Injuries. Am Surg. 2023;89(12):5492\u2013500.","DOI":"10.1177\/00031348231157416"},{"key":"1576_CR25","doi-asserted-by":"crossref","unstructured":"Helling TS, Ward MR, Balon J. Is the grading of liver injuries a useful clinical tool in the initial management of blunt trauma patients? Europ J Trauma Emerg Surg. 2009;35(2):95\u2013101.","DOI":"10.1007\/s00068-008-8156-z"}],"container-title":["Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13049-026-01576-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-026-01576-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-026-01576-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T10:45:25Z","timestamp":1776163525000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13049-026-01576-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1576"],"URL":"https:\/\/doi.org\/10.1186\/s13049-026-01576-7","relation":{},"ISSN":["1757-7241"],"issn-type":[{"value":"1757-7241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"24 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by Nottingham University Hospital Clinical Audit Team (ID Reference 22-709C)\u00a0and University Hospitals Birmingham NHS Foundation Trust Clinical Audit Registration and Management System (ID Reference CARMS 19146).\u00a0Consent for participation in the study was not obtained as this was a large retrospective audit with anonymised data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"N\/A.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"70"}}