Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?

George A Giannopoulos,Panayotis A Patsaouras,Michalis K Digalakis,Nikolaos E Tzanakis,Iraklis E Katsoulis

doi:10.1186/1757-7241-17-22

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

Introduction

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-

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Discussion

Conclusion