EGS P06 Pattern of oesophago-gastric injuries and its outcome in major trauma and tertiary UGI centre

Abstract

Abstract Background Oesophago-gastric injuries in major trauma are relatively rare. These injuries are known to be associated with high morbidity and mortality. Major trauma involving oesophagus and stomach are linked with high velocity, high impact blunt or penetrating force. There is also a strong association between oesophago-gastric injuries and other systemic injuries including thoracic, major vessels, skull, brain and abdominal viscerae. In this study we aimed to evaluate the pattern of injury in oesophageal and gastric major trauma its association with widely used injury severity score (ISS), multi organ system involvement, survival and factors affecting mortality. Methods Patients presenting between January 2012 and December 2022 as major trauma as moderate / severe trauma (ISS > 9) with oesophageal and gastric injuries were included in this study. Retrospective analysis was carried out on prospectively maintained trauma data base in an urban major trauma centre with specialist tertiary upper GI cover. Mechanism of injury, ISS and mortality were calculated. Analysis was carried out on variables to identify factors contributing to overall index admission mortality. MedCalc ® was used to perform statistical analysis. Results A total of 8984 patients presented in urban major trauma centre with moderate to severe trauma (ISS >9). Among them 13 had gastric injuries and 3 had oesophageal injuries (total n=16). Mechanism of injury in gastric patients was blunt force in 8 (61.5%) and penetrating force was in 5 (38.5%) patients whereas all oesophageal injuries were linked with penetrating trauma. Median ISS in gastric injuries was 17 and in oesophageal injuries was 34. Overall mortality was 31.2%(n=5). Variables including high ISS, thoracic injury, diaphragmatic rupture, skull injuries & blood transfusion were linked with mortality on multivariate logistic regression. Conclusions Our study finds an association of oesophago-gastric injuries with high impact penetrating and blunt trauma. Presence of oesophageal and gastric injuries are surrogate indicators of severity of trauma, it is not only associated with high ISS but also has relatively high mortality. Therefore, early involvement of specialist senior decision maker in time critical setting is recommended. Due to scarce volume of OG trauma, national UGI trauma collaborative can be helpful to share experience, learn lessons and promote research.