The worldwide variation in epidemiology of pancreatic injuries

Abstract

Due to the relative rarity of trauma to the pancreas, experience with pancreatic injury is highly variable among surgeons. Considerable differences exist in epidemiology, aetiology, management and outcomes around the globe [ [1] Soreide K. Weiser T.G. Parks R.W. Clinical update on management of pancreatic trauma. HPB (Oxford). 2018; 20: 1099-1108 Google Scholar ]. Higher rates of penetrating injuries have traditionally been reported from regions with excessive access to and frequent use of handguns in civilian populations, most notably in South Africa and the United States [ 2 Krige J.E. Kotze U.K. Setshedi M. Nicol A.J. Navsaria P.H. Prognostic factors, morbidity and mortality in pancreatic trauma: a critical appraisal of 432 consecutive patients treated at a Level 1 Trauma Centre. Injury. 2015; 46: 830-836 Google Scholar , 3 Phillips B. Turco L. McDonald D. Mause E. Walters R.W. A subgroup analysis of penetrating injuries to the pancreas: 777 patients from the National Trauma Data Bank, 2010–2014. J Surg Res. 2018; 225: 131-141 Google Scholar , 4 Kuza C.M. Hirji S.A. Englum B.R. Ganapathi A.M. Speicher P.J. Scarborough J.E. Pancreatic injuries in abdominal trauma in US adults: analysis of the national trauma data bank on management, outcomes, and predictors of mortality. Scand J Surg. 2019; 1457496919851608 Google Scholar , 5 Alemayehu H. Tsao K. Wulkan M.L. et al. Multi-institutional experience with penetrating pancreatic injuries in children. Pediatr Surg Int. 2014; 30: 1107-1110 Google Scholar , 6 Mohseni S. Holzmacher J. Sjolin G. Ahl R. Sarani B. Outcomes after resection versus non-resection management of penetrating grade III and IV pancreatic injury: a trauma quality improvement (TQIP) databank analysis. Injury. 2018; 49: 27-32 Google Scholar ]. Audits on pancreatic trauma done outside regions of high prevalence of penetrating injuries have been rare to come across, although some have been reported [ [7] Scollay J.M. Yip V.S. Garden O.J. Parks R.W. A population-based study of pancreatic trauma in Scotland. World J Surg. 2006; 30: 2136-2141 Google Scholar , [8] O’Reilly D.A. Bouamra O. Kausar A. Malde D.J. Dickson E.J. Lecky F. The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989–2013. Ann R Coll Surg Engl. 2015; 97: 125-130 Google Scholar ]. Thus, the current report from Japan [ [9] [authors] Epidemiological state, predictive model for mortality, and optimal management strategy for pancreatic injury: a multicentre nationwide cohort study. Injury. 2019; (in press) Google Scholar ] in this issue of Injury is timely and sheds some further light on the spectrum of pancreatic injuries as seen in a nationwide cohort. The nationwide data report allows to compare the likes and dislikes between other regions as well as outcomes associated with this overall rare organ injury (Table 1). Table 1Registry studies of pancreatic injuries covering a defined geographic region. Origin Period Pancreatic (n) All * All, denotes of all trauma patients in the study/register. (%) Abd. (%) Blunt (%) Morb (%) Mort (%) Japan 2004–2017 743 0,25 2,4 85% n.r. 17,5% UK 1989–2013 724 0,20 2,9 82% n.r. B:21,2%P:16,8% Scotland 1992– 2002 111 0,21 n.r. 66% n.r. 46,0% USA 2007– 2011 8386 0,30 3,6 61% 53% 21,2% ‘Abd’, denotes ‘abdominal injuries’; ‘morb’, denotes ‘morbidity’; ‘mort’, denotes ‘mortality’. B, denotes ‘blunt’; P, denotes ‘penetrating’. * All, denotes of all trauma patients in the study/register. Open table in a new tab ‘Abd’, denotes ‘abdominal injuries’; ‘morb’, denotes ‘morbidity’; ‘mort’, denotes ‘mortality’. B, denotes ‘blunt’; P, denotes ‘penetrating’.