The management of liver trauma has improved considerably over the past 2 decades. However, much of the evidence for this improvement has emanated from major trauma centres. Little information is available from peripheral hospitals which deal with much of the trauma seen in Australia. This study set out to examine the management of liver trauma in Box Hill Hospital over the past 2 decades; 74 patients were treated for liver trauma during 1967-86, and the factors considered contributory to mortality rate were analysed. The overall mortality rate was 33.8%, but each 5-year period saw a reduction in mortality rate (25% in the 1982-86 period). The patient's age, associated injuries, transfusion requirements, degree of liver injury and postoperative haemorrhage all contributed to a higher mortality rate. This study indicated that management of liver trauma in a peripheral hospital results in mortality rates that are comparable with major trauma centres. Moreover, by highlighting treatment deficiencies through self-audit, improved treatment protocols should further enhance survival prospects.