**7. Morbidity and mortality**

Mortality rates for hepatic injury vary as per grade of the injury, associated injuries, and general condition of the patient. The outcome has improved over the years, and the major contributing factors are the new approaches in form of nonoperative management strategies, damage control, and use of perihepatic packing. Since mortality is rarely seen with Grade I and II injuries, the reduction seen was difficult to perceive. However, reduction in operative mortality has seen a great decline especially for higher-grade liver injuries (Grades III, IV, and V). The overall mortality rate may vary from 10% to 42% as per the higher grade of injuries [31].

Many studies have evaluated factors determining the mortality of hepatic injury treated by surgical management. Various factors have been found to have strong association with rate of

**Figure 5.** Algorithm For Nonoperative Management of Blunt Hepatic Trauma (adopted from Western Trauma Associ‐ ation critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 67:1144–1148, 2009).

mortality, which includes hemodynamic instability, coexisting musculoskeletal and chest injury, high levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), long activated partial thromboplastin time (APTT), prothrom‐ bin time (PT), low fibrinogen levels, and platelet counts on admission. Not surprisingly, mortality is notably decreased when the liver trauma is managed by hepatobiliary surgeon if feasible [57].
