Morbidity and mortality after distal pancreatectomy for trauma: A critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre

Krige, J. E. J.; Kotze, U.; Nicol, Andrew; Navsaria, Pradeep

doi:10.1016/j.injury.2014.04.024

Cited by 38 publications

(29 citation statements)

References 44 publications

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“…The organ injury scale (OIS) by American Association for Surgery of Trauma (AAST) for pancreatic injury severity Legend:Table 2) and found an overall good prediction (AUC of 0.84) in a series of 473 patients with pancreatic injuries. Further external validation is needed to test the robustness of this score, but this may prove difficult given that few, if any centres, have the same experience as the vast numbers reported by the Cape Town group over the years 7,32,33,[61][62][63]. …”

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confidence: 99%

Clinical update on management of pancreatic trauma

Søreide

Weiser

Parks

2018

HPB

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mentioning

confidence: 99%

Clinical update on management of pancreatic trauma

Søreide

Weiser

Parks

2018

HPB

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“…Some investigators have reported Clavien-Dindo complication scores following trauma 10–12 but without an explanation regarding how any modifications were made or whether there were any issues with translating the scoring system from elective surgery to emergency trauma management. Furthermore, they do not cite any source or justification for their utilization of Clavien-Dindo.…”

Section: Discussionmentioning

confidence: 99%

An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint

Naumann

Vincent

Pearson

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background There is no consensus on reporting non-mortality trauma complications in a graded manner. The Clavien-Dindo scale of complications was originally for elective surgery, and requires adaptation to provide meaningful data for trauma patients. In particular the original score does not account for those treated without surgery. We report an adapted Clavien-Dindo in trauma (ACDiT) scale and apply it to patients managed operatively and non-operatively. Methods A combined prospective and retrospective international multi-center observational study was undertaken to apply the ACDiT scale to 484 trauma patients at 3 university teaching hospitals (Birmingham, England (n=303); Houston, Texas (n=113); and Glasgow, Scotland (n=68)). These included both intensive care (ICU) and non-ICU managed patients. The Clavien-Dindo scoring system was adapted for trauma patients based on consensus amongst an international collaboration of trauma specialists at these sites. Data included whether initial patients were managed operatively or non-operatively. Complication grades were compared to hospital-free and ICU-free days as other outcome measures of patient morbidity. Results 217/484 (44.8%) patients experienced complications, of whom 61/217 (28.1%) died (Grade V). The remainder consisted of grades I (n=20), II (n=60), III (n=24) and IV (n=52). There was a strong association between higher ACDiT grade category and lower number of hospital-free and ICU-free days (p<0.01). Eighty-eight patients with complications did not require surgery, validating the score’s usefulness in patients managed non-operatively. Conclusions The ACDiT scale can be used to grade the severity of post-trauma complications in patients managed both operatively and non-operatively. It provides clinically meaningful data for morbidity and mortality meetings and other quality improvement exercises.

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“…liver, splenic, renal and/or vascular injury). Penetrating trauma (gunshot, stab wound) appears to be the main cause of pancreatic trauma in the United States and South Africa (15,16,17), while in the rest of the world pancreatic trauma is mainly blunt and related to road traffic accidents (up to 54 -85%), sport injuries and falls (4,18). Blunt abdominal trauma by bicycle handle bar is responsible for every third-second paediatric pancreatic trauma (19,20).…”

Section: Mechanism Of Pancreatic Injury Mechanism Of Pancreatic Injurymentioning

confidence: 99%

“…The spontaneous resolution of small pseudocysts is common, but the larger ones require active, sometimes repetitive treatment. More than 90% of traumatic pancreatic fistulas close within 8 weeks with conservative treatment (17). Fistulas which the grading of the depending on its output helps in determining prognosis (53).…”

Section: Morbidity and Mortality Related Morbidity And Mortality Relamentioning

confidence: 99%

Diagnosis and Management of Blunt Pancreatic Trauma

Kollár

Molnár

Zsoldos

et al. 2018

SGO

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Introduction: Blunt or penetrating pancreatic trauma represents only 0.2-2% of all trauma cases and approximately 3-12% of all abdominal injuries. While treatment protocol debates of other intra-abdominal and thoracic organ injuries seem to reach comforting conclusions, satisfying evidence-based recommendations regarding the pancreas have not been released yet. However, high grade trauma of the pancreas can lead to substantial morbidity and mortality. The question is, when and how to treat it conservatively or operatively. Objectives/Methods: This study is a review of contemporary literature on children and adult pancreatic trauma management strategies and findings. The purpose is to evaluate current classifications and the efficacy of subsequent non-operative and operative treatments. We list the established grading systems starting from physical examination, imaging diagnosis, to indications for surgery or conservative management, followed by post-treatment morbidity and mortality rates. Conclusions: Current operative or non-operative management strategies are not based on randomized -or even, in fact, on prospective -clinical trials. Most of the available publications demonstrate small retrospective patient cohorts and expert opinions. To date, no convincing high level (at least Level III) evidence-based recommendations have been published in terms of treatment of these injuries. There is a general agreement, that the injury of the main pancreatic duct is the thin red line, dividing conservative and operative strategies. Low grade pancreatic injury can be treated conservatively not significantly different from protocols developed for mild pancreatitis of other origin. Pancreatic duct damage in adults requires either minimal invasive intervention or exploration and reconstruction/resection via laparotomy. Treatment strategies of high grade paediatric pancreatic injuries remain controversial. Associated organ injuries can mask the symptoms of pancreatic trauma. Missed main pancreatic duct injuries pose a clinically challenging situation with serious complications and considerable mortality. Pancreatic injury in polytrauma poses the highest risk. Present perspectives for survival of pancreatic injury as mono trauma varies between 95-100%, while as a part of polytrauma, the mortality rate is as high as 30-35%. Multicentre prospective, randomized clinical trials would be ideal to support optimal decision making. Heterogeneity of cases and relative rarity of the pathology makes the creation of such a database highly unlikely.Pancreatic injury makes up a relatively small proportion of trauma cases: the pancreas is affected in 0.2-2% of all trauma patients and in 2-12% of all

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Morbidity and mortality after distal pancreatectomy for trauma: A critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre

Cited by 38 publications

References 44 publications

Clinical update on management of pancreatic trauma

Clinical update on management of pancreatic trauma

An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint

Diagnosis and Management of Blunt Pancreatic Trauma

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