Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication.

Ayman El-Menyar,Ahmad Zarour,Husham Abdelrahman,Ashok Parchani,Rifat Latifi,Ruben Peralta,Hassan Al-Thani

doi:10.1186/1752-2897-8-14

Abstract

BackgroundThe mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments.Patients & methodsWe conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed.ResultsOf 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29 ± 13) and highest in TAC (34 ± 11) group, (P = 0.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; P = 0.001) and need for blood transfusion (OR 3.03; P = 0.003) were the main independent predictors of mortality.ConclusionIn addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification.

Highlights

Trauma is a leading cause of hospitalization, long-term disabilities and mortality worldwide [1]
Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had traumatic abdominal injury (TAI) that were grouped as intrathoracic abdomen (ITC) (65%), RPC (15%), TAC (13%), and pelvic abdominal compartment (PAC) (7%)
In addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI

Summary

Introduction

Trauma is a leading cause of hospitalization, long-term disabilities and mortality worldwide [1]. In respect to the mechanism of injury (MOI), Motor Vehicle Crash (MVC) is a common cause of admission to the emergency department, the most likely injury pattern to be assessed [2]. This step should be followed by simultaneous physical examination and bedside imaging. As data describing the epidemiology of TAI in each abdominal compartment is lacking worldwide, we thought to study the mechanism, patterns and outcome of TAI in relation to the four arbitrary abdominal compartments which have not been reported yet. We aimed to assess from the academic point of view, TAI based on its anatomical compartments

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