The liver is the most commonly afflicted organ in abdominal trauma, manageable conservatively or operatively. However, debate persists over case selection for operative management. We aimed to evaluate our experience with liver trauma management and provide insights for improved case management.

In this retrospective cross-sectional study, all patients with traumatic liver injury over a five-year period were evaluated. Imaging studies were reassessed by radiologists to calculate the Injury Severity Score (ISS). Treatment trends and comparisons between operatively and non-operatively managed patients were analyzed.

A total of 209 patients (mean age 34.72 ± 16.1 years, 79.4% male) included 45.9% (n=96) managed non-operatively and 54.1% (n=113) operatively, with 23.9% (n=50) mortality. AAST Grade V injuries occurred in 1.9% (n=4); 48.3% (n=101) had ISS ≥25. AAST predicted operative need (P=0.037) but not mortality (P=0.217); ISS predicted mortality (P=0.041) but not operative management (P=0.432). Operative predictors included penetrating trauma (aOR=5.12, P=0.011), transfusion (aOR=1.58, P<0.001), volume resuscitation (aOR=1.89, P<0.001), catecholamine use (aOR=2.97, P=0.017), and AAST IV/V (aOR=4.25, P=0.006). Mortality correlated with age, lower Glasgow Coma Scale (GCS), and transfusion needs.

ISS excels in mortality prediction, while AAST and resuscitation markers guide operative decisions. Integrating these enhances trauma care precision.