Predicting the Outcome of Non‐operative Management of Splenic Trauma in South Africa

Hernandez, Matthew C.; Traynor, Michael D.; Knight, Ariel W.; Kong, Victor; Laing, G L; Bruce, John; Bekker, W; Zielinski, Martin D.; Clarke, Damian

doi:10.1007/s00268-020-05370-z

Cited by 3 publications

(1 citation statement)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, the need for ICU admission was associated with NOM failure. Our result was similar to the previous report by Hernandez et al [ 30 ]. In this study, the need for ICU admission was associated with operative management needs in univariate analysis, but not mortality.…”

Section: Discussionsupporting

confidence: 94%

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study

Obadiel,

Albrashi,

Allahabi

et al. 2024

Cureus

View full text Add to dashboard Cite

Background: The treatment of penetrating abdominal injuries has changed in recent years with more focus on "nonoperative management" (NOM) to avoid unnecessary laparotomies while identifying injuries early. Although the NOM approach is widely used for stab wounds, its effectiveness in managing abdominal gunshot wounds is controversial. NOM of penetrating abdominal injuries is becoming more dependent on hemodynamic stability and improved noninvasive radiological interventions. The role of NOM is significantly underreported and underestimated in developing countries, particularly in fragile and conflict-affected states such as Yemen. The present study aims to evaluate the clinical outcomes of NOM in penetrating abdominal trauma injury patients and identify factors associated with NOM failure in a low-resource setting. Methods: A retrospective study from January 2021 to December 2022 including patients diagnosed with penetrating abdominal trauma at the General Military Hospital, Sana'a, Yemen, was conducted. Hemodynamically stable patients without peritonitis or clear indications for immediate laparotomy were candidates for NOM and were included in the study. Patients with blunt abdominal injuries, penetrating wounds outside the abdomen, particularly head injury, eviscerated structures, and gastrointestinal hemorrhage, or those pronounced dead on arrival were excluded. The primary outcome was the success and failure rate of NOM necessitating laparotomy. The secondary outcome was the factors associated with NOM failure. Results: During the study, 256 patients with penetrating abdominal injury were admitted, with 222 (86.7%) undergoing immediate laparotomy and 34 (13.3%) treated with NOM. The mean age was 27.6±7.4 years. Bump explosions, mostly sharp objects (secondary blast injuries), were the main causes of injury (n=18, 52.9%). Other causes were low-velocity gunshot wounds, stab wound injuries, and shotgun injuries in 14 (41.2%), one (2.9%), and one (2.9%), respectively. The majority of patients (n=25, 55.9%) were admitted within 6-24 hours of the incident. The abdominal computed tomography (CT) scan revealed various injuries in all patients, including hemoperitoneum in 11 (32.4%), pneumoperitoneum in five (14.7%), liver injury in 15 (44.1%), foreign body attached to the wall colon in 23 (67.6%), kidney injury in two (5.9%), and splenic injury in one (2.9%). NOM was successful in 31 (91.2%) patients. NOM failed in three (8.8%). One patient was treated via the laparoscopic procedure, and two patients were treated with laparotomy procedures. Five (14.7%) cases required intensive care unit (ICU) admission, with no deaths or major complications. In univariate analysis, the presence of free intra-abdominal fluid (pneumoperitoneum) on the initial CT scan and the need for ICU admission were associated with NOM failure and were statistically significant (p<0.05). Conclusion: Our findings support that some penetrating abdominal trauma patients can benefit from NOM. The goal of preventi...

show abstract

Section: Discussionsupporting

confidence: 94%

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study

Obadiel,

Albrashi,

Allahabi

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

Spread and feasibility of non-operative management (NOM) of traumatic splenic injuries in adults: a national survey

Visconti,

Parini,

Mariani

et al. 2023

Updates Surg

View full text Add to dashboard Cite

Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis

Endeshaw,

Delie,

Adal

et al. 2024

BMC Emerg Med

View full text Add to dashboard Cite

Background Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa. Method This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I2 test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests. Result This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52). Conclusion Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.

show abstract

Predicting the Outcome of Non‐operative Management of Splenic Trauma in South Africa

Cited by 3 publications

References 39 publications

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study

Spread and feasibility of non-operative management (NOM) of traumatic splenic injuries in adults: a national survey

Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis

Contact Info

Product

Resources

About