WHEN AGE MEETS IMPACT: EXPLORING HIGH-GRADE LIVER TRAUMA IN OLDER ADULTS krusso4@emory.edu

PW05-09

WHEN AGE MEETS IMPACT: EXPLORING HIGH-GRADE LIVER TRAUMA IN OLDER ADULTS

5

United States

Oral or Poster

The liver is among the most frequently injured solid organs in trauma, yet management data in older adults remains limited. This population faces higher mortality and increased risk of intra-abdominal injury from low-energy mechanisms. We aimed to investigate patients over age 65 with high-grade liver injuries (HGLIs) to characterize management and outcomes.

Retrospective review was conducted of patients age ≥65 with HGLIs (AAST grades III-V) admitted to an urban Level 1 trauma center from 2016 to 2024.

Of the 213 patients, 67 sustained HGLIs with a median age of 73 [67-79]. 88.1% resulted from blunt mechanisms, 67.2% were managed nonoperatively, and 61% sustained grade III injuries. Among those requiring intervention, 11.9% underwent angioembolization, 16.4% operative management, and 4.5% both. NOM failure was 4.5% and mortality 10.4%. Groups differed significantly in presenting SBP (p=0.003), transfusion requirement (NOM 22.2% vs. OR+AE 100%, p<0.001), and LOS (OR group median 28 days, p=0.035). Complication rates, including pneumonia (p=0.001), AKI (p=0.043), and tracheostomy/PEG (p=0.001), were highest in the OR group. Discharge disposition differed significantly (p<0.001), with OR patients most frequently discharged to a facility (54.5%).

In our cohort, mortality and NOM failure rates were lower than those reported in the general trauma population. Operative management was associated with longer LOS, higher complication rates, and facility discharge. Greater angioembolization utilization may improve outcomes in select older adults with HGLIs.