The Burden of Liver Trauma in an Urban Trauma Centre in Johannesburg, South Africa

Background: Liver trauma is prevalent in blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods A retrospective analysis was conducted on 512 priority one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, Injury Severity Scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata and R software. Results The median age of the patients was 31 years, with a predominance of male patients (91%) and of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I – III). There was an overall 5% mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore mortality and complications.