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Invited Critique |

Trauma and Cirrhosis:  Comment on “The Model for End-stage Liver Disease Score”

Ali Salim, MD
Arch Surg. 2011;146(9):1079. doi:10.1001/archsurg.2011.108.
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Cirrhosis is present in approximately 1% of all patients with trauma admitted to a trauma center and is a well-known risk factor for increased morbidity and mortality following injury. For this reason, the American College of Surgeons recommends that prehospital providers transport trauma patients who have a history of cirrhosis to a trauma center. The worst outcomes seen following trauma are due to the increased propensity for bleeding caused by portal hypertension and underlying coagulopathy, as well as the presence of ascites that often leads to malnutrition and sepsis. Scoring systems such as the Child-Turcotte-Pugh classification system and the model for end-stage liver disease (MELD) score provide information regarding the severity of cirrhosis and are used to predict outcome following elective surgery. These indices have also been used to predict outcome following trauma.13

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