Abstract
BackgroundTo evaluate the feasibility and safety of non-operative management (NOM) of blunt abdominal trauma in a district general hospital with middle volume trauma case load.MethodsProspective protocol-driven study including 30 consecutive patients who have been treated in our Department during a 30-month-period. Demographic, medical and trauma characteristics, type of treatment and outcome were examined. Patients were divided in 3 groups: those who underwent immediate laparotomy (OP group), those who had a successful NOM (NOM-S group) and those with a NOM failure (NOM-F group).ResultsNOM was applied in 73.3% (22 patients) of all blunt abdominal injuries with a failure rate of 13.6% (3 patients). Injury severity score (ISS), admission hematocrit, hemodynamic status and need for transfusion were significantly different between NOM and OP group. NOM failure occurred mainly in patients with splenic trauma.ConclusionAccording to our experience, the hemodynamically stable or easily stabilized trauma patient can be admitted in a non-ICU ward with the provision of close monitoring. Splenic injury, especially with multiple-site free intra-abdominal fluid in abdominal computed tomography, carries a high risk for NOM failure. In this series, the main criterion for a laparotomy in a NOM patient was hemodynamic deterioration after a second rapid fluid load.
Highlights
To evaluate the feasibility and safety of non-operative management (NOM) of blunt abdominal trauma in a district general hospital with middle volume trauma case load
No significant differences were observed between operated immediately (OP) and NOM-S group in relation with age, sex, comorbidities, extra-abdominal trauma and mechanism of injury (Table 1)
In NOM-S group significantly fewer patients were intubated in emergency department (ED) and presented with hypotension and tachycardia
Summary
To evaluate the feasibility and safety of non-operative management (NOM) of blunt abdominal trauma in a district general hospital with middle volume trauma case load. Advances in medical imaging and minimally invasive techniques have highly contributed to the extension of non-operating management (NOM) in more severe, complex, even penetrating injuries. NOM is considered as standard of care in all hemodynamically stable injured adults without peritoneal signs and numerous recent studies demonstrate success rates exceeding 80% [2,3,4,5,6]. NOM of liver injuries has an even higher success rate, exceeding 90% [3]. Velmahos et al.[7] support that the liver is a sturdy organ and conclude that in the absence of peritoneal signs and irreversible instability, all liver inju-
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
