Epidemiological state, predictive model for mortality, and optimal management strategy for pancreatic injury: A multicentre nationwide cohort study

Shibahashi, Keita; Sugiyama, Kazuhiro; Kuwahara, Yusuke; Ishida, Takuto; Okura, Yoshihiro; Hamabe, Yuichi

doi:10.1016/j.injury.2019.08.009

Cited by 20 publications

(50 citation statements)

References 30 publications

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“…4 In Japan, more than 90% of these injuries are caused by blunt trauma resulting from traffic accidents. 4,11 MPD involvement is the most important factor of patient outcomes, and delays in diagnosis are associated with high postoperative morbidity and mortality rates, particularly in cases of MPD injury. 12 Because the pancreas is surrounded by the liver, biliary tract, spleen, stomach, duodenum, colon, and large blood vessels, the frequency of concomitant other organ injury is also high.…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate is relatively high in such cases. 4,13 The frequency of single pancreatic injury is less than 10%. The number of concurrently damaged organs averages 3.5-4.1, with mortality increasing with the number of damaged organs.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic trauma is relatively rare, with an overall frequency of only 0.2%-0.3% among all trauma but a high mortality rate of 17%-46%. [1][2][3][4] Pancreatic fistula is one of the major complications of pancreatic trauma. This can contribute to prolonged hospital stays and fatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Some reports stated that delayed diagnosis and inappropriate treatment of main pancreatic duct (MPD) injury could increase both complications and mortality rates. [4][5][6] However, because of limited cases at a single institution, experienced specialists and high-quality evidence are scarce. Consequently, a consensus regarding diagnostic and treatment algorithms as well as optimal surgical selection has not been established.…”

Section: Introductionmentioning

confidence: 99%

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Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

Ando

Okano

Yasumatsu

et al. 2021

J Hepato Biliary Pancreat

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Background: Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment. Methods: As a study project of the Japanese Society for Abdominal Emergency Medicine (JSAEM), we collected the data of 163 patients with pancreatic trauma who were diagnosed and treated at JSAEM board-certified hospitals from 2006 to 2016. Clinical backgrounds, diagnostic approaches, management strategies, and outcomes were evaluated. Results: Sixty-four patients (39%) were diagnosed as having pancreatic trauma with MPD injury that resulted in 3% mortality. Blunt trauma and isolated pancreatic injury were independent factors predicting MPD injury. Nine of 11 patients with MPD injury who were initially treated nonoperatively had serious clinical sequelae and five (45%) required surgery as a secondary treatment. Among all cases, the detectability of MPD injury of endoscopic retrograde pancreatography (ERP) was superior to that of other imaging modalities (CT or MRI), with higher sensitivity and specificity (sensitivity = 0.96; specificity = 1.0). Conclusions: Acceptable outcomes were observed in pancreatic trauma patients with MPD injury. Nonoperative management should be carefully selected for MPD injury. ERP is recommended to be performed in patients with suspected MPD injury and stable hemodynamics. K E Y W O R D S endoscopic retrograde pancreatography, main pancreatic duct injury, management, nationwide survey, pancreatic trauma This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

Ando

Okano

Yasumatsu

et al. 2021

J Hepato Biliary Pancreat

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“…Pancreatic trauma is an uncommon but important concern with a mortality rate of 3-70% in adult patients [1,2]. It accounts for 1-2% of blunt abdominal trauma and 5-7% of penetrating abdominal trauma.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Outcome and Survival after Laparotomy in Patients with Pancreatic Trauma: One Single-center Experience.

Yang¹,

Liu²,

Wu³

et al. 2020

Preprint

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Background: Pancreatic trauma results in significant morbidity and mortality. Few studies have investigated the postoperative prognostic factors in patients with pancreatic trauma after surgery. Methods: A retrospective study was conducted on 152 consecutive patients with pancreatic trauma who underwent surgery in Jinling Hospital, a national referral trauma center in China, from January 2012 to December 2019. Univariate and binary logistic regression analyses were performed to identify the perioperative clinical parameters that may affect the morbidity of the patients. Results: A total of 184 patients with pancreatic trauma were admitted during the study period, and 32 patients with nonoperative management were excluded. The remaining 152 patients underwent laparotomy due to pancreatic trauma. Sixty-four patients were referred from other centers due to postoperative complications. Abdominal bleeding caused by pancreatic leakage ( 10 of all deaths) and severe intra-abdominal infection (12 of all deaths) were the major causes of mortality. Twenty-eight (77.8%) of the 36 patients who had damage control laparotomy survived. Univariate analysis showed that age, hemodynamic status, and injury severe score (ISS) as well as postoperative serum levels of C-reactive protein (CRP), procalcitonin, albumin and creatinine and the volume of intraoperative blood transfusion had significant effects on the mortality ( P <0.05). Binary logistic regression analysis showed that the independent risk factors for prognosis after pancreatic trauma surgery were age ( P =0.012), preoperative hemodynamic instability ( P =0.018), postoperative CPR ≥154 mg/L ( P =0.016), and postoperative serum creatinine ≥177 μmol/L ( P =0.017). The 30-day mortality rate was 15.8%. Conclusions: In this single-center retrospective study, we first demonstrated that severe intra-abdominal infection and bleeding were the major factors affecting the prognosis of patients with pancreatic trauma after surgery. Preoperative hemodynamic instability, severe postoperative inflammation (CRP ≥154 mg/L) and acute renal failure (creatinine ≥177 μmol/L) were associated with a significant risk of mortality.

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Management and Outcome of Blunt Pancreatic Trauma: A Retrospective Cohort Study

Gao

Jiang

et al. 2023

World j. surg.

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Background Pancreatic injury is rare, but it has a high mortality rate and its optimal treatment remains controversial. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with blunt pancreatic injury. Methods This retrospective cohort study was performed on patients with a confirmed blunt pancreatic injury who were admitted to our hospital from March 2008 to December 2020. The clinical characteristics and outcomes of patients receiving different management strategies were compared. The risk factors for in-hospital mortality were evaluated by performing a multivariate regression analysis. Results A total of 98 patients diagnosed with blunt pancreatic injury were identified, with 40 patients having undergone nonoperative treatment (NOT) and 58 patients having undergone surgical treatment (ST). The overall inhospital deaths were 6 (6.1%), including 2 (5.0%) and 4 (6.9%) in the NOT and ST groups, respectively. Pancreatic pseudocysts occurred in 15 (37.5%) and 3 (5.2%) of the NOT and ST groups, respectively, showing a significant difference between the two groups (P \ 0.001). In the multivariate regression analysis, concomitant duodenal injury (OR = 14.42, 95% CI 1.27-163.52; P = 0.031) and sepsis (OR = 43.47, 95% CI,; P = 0.002) were independently associated with in-hospital mortality. Conclusions Except for the higher incidence of pancreatic pseudocysts in the NOT group than in the ST group, there were no significant differences in the other clinical outcomes between the two groups. Concomitant duodenal injury and sepsis were the risk factors for in-hospital mortality.

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Epidemiological state, predictive model for mortality, and optimal management strategy for pancreatic injury: A multicentre nationwide cohort study

Cited by 20 publications

References 30 publications

Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

Prognostic Factors for Outcome and Survival after Laparotomy in Patients with Pancreatic Trauma: One Single-center Experience.

Management and Outcome of Blunt Pancreatic Trauma: A Retrospective Cohort Study

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