Non-operative management of blunt abdominal solid organ trauma in adult patients

Abstract

Introduction Despite agreement in the literature that “stable” blunt trauma patients may be managed conservatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP) management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta University Emergency Hospital (TUH) in Egypt. Methods A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ injury at TUH over a 3-year period (June 2014–June 2017). Inclusion criteria were age ≥18 yr, mean arterial pressure >65 mm Hg, heart rate <110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; patients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All patients were assigned to non-operative or operative management based on clinician preference. Outcomes of interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ 2 were used to compare outcomes. Results During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10 – NOP vs. 28 ± 11 – OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP] vs.1155.17 ± 380.4 ml [OP] ( p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs. 6.45 ± 1.97 days [OP] ( p = 0.012)). There was no difference in mortality between groups ( p = 0.091). Conclusion Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer length of stay for non-operative patients might reflect treating physician caution in their management.

Solid Organs Injuries in Blunt Abdominal Trauma Patients

“…This agreed with Sisodiya and Malpani (12) who showed that 61% cases were managed non-operatively or conservatively and 32 % had to undergo operative intervention. The current study results were also in accordance with Ibrahim et al (8) who showed that eighty two (73.9%) of the included cases underwent NOM and 29 (26.1%) underwent OM.…”

“…However, Sisodiya and Malpani (12) in their study showed that conservative management has a significant decrease in length of hospital stay (LOS) and morbidity compared to the patient who undergoes surgery. Moreover, Ibrahim et al (8) showed that the mean LOS was 8.29 ± 2.8 days for NOP patients vs 6.45 ± 1.97 days for OP patients, (p = 0.012). All patients in the NOP group survived, whereas one OP patient died (p > 0.05).…”

“…This agreed with the results of the current study as cases with blunt abdominal trauma (BAT) represented 7.4% of the polytrauma cases presented to MUEH and 74.7% of the cases with abdominal trauma. Approximate incidence was shown by Ibrahim et al (8) who included 4254 trauma patients presented to Emergency Department (ED) in Tanta University Emergency Hospital, from them 790 patients had blunt abdominal trauma and 111 (14.1%) met inclusion criteria.…”

The Pattern of Abdominal Trauma in Ramadi city: An Experience of 74 Cases

“…This study has also shown that the males were more injured than females with a ratio of male to female 9.6 to 1 which agrees with other studies [3][11][16] [17][18] [12]. This may be attributed to that males are more prevalent in outdoor activities, more found in assaults injuries, and participating in certain jobs like a soldier.…”

“…The prevalence of abdominal trauma in the Middle East ranged from 15-82% [11]. The prevalence rate of the abdominal trauma from the total cases of trauma admitted to the emergency unit in the present study (6.6%) was less than the study by Ibrahim et al (14.1%) [12]. This may be attributed to that considerable cases were excluded from the current study Fig.…”