Intra-abdominal Solid Organ Injuries Research Articles

Cases of pediatric intra-abdominal solid organ injury induced by blunt trauma experienced over a 15-year period at two centers in Japan

ObjectiveThe present study attempts to clarify the clinical features of pediatric intra-abdominal solid organ injury at two institutions.MethodsThe injured organ, patient age, sex, injury grade, imaging findings, intervention, length of...

Early ambulation in solid intra abdominal organ injury following blunt abdominal trauma in paediatric patients

BackgroundUncertainty exists surrounding the optimal time for ambulation in paediatric patients who have been conservatively managed post intra-abdominal solid organ injury (IASOI) following blunt abdominal trauma, specifically the safety of early ambulation. This study aims to assess the safety of early ambulation in this population. MethodsA single centre retrospective chart review of paediatric patients 15 years old and younger over a 10-year period 01 January 2010 – 31 December 2020 was conducted. Data was collected regarding demographics, time to ambulation, mean length of stay (LOS), Mechanism of Injury (MOI), need for intervention (operative, interventional radiological or medical), opiate analgesia prescription on discharge, and time to return to full physical activity. Logistical regression using Fishers Exact test was used in statistical analysis. ResultsOf the 138 patients included in the study, 115 (83%) sustained an isolated IASOI and 23 (17%) a multiple IASOI. The mean grade of injury for both isolated and multiple IASOI was 3.0. The mean time to ambulation was 2.5 days in isolated IASOI and 2.8 in multiple IASOI. In isolated IASOI, with the exception of pancreatic injures for all other organs over all grades, the mean time to ambulation in children was prior to the grade + rule in days. There were 6 complications (4%) requiring intervention (operative or interventional radiology). There were no cases of delayed haemorrhage in our study population. ConclusionEarly ambulation in isolated IASOI is safe and does not lead to clot destabilization and further haemorrhage requiring intervention. Level of evidenceIII

A Case of Hepatic Injury Following Shrapnel Injury to the Abdomen in a Paediatric Patient

In children, trauma is the leading cause of morbidity and mortality worldwide. Trauma can be a catalyst resulting in intra-abdominal solid organ injury in this population. The case report highlights a prepubescent male who presented with a penetrating abdominal wound resulting in hepatic injury. The mechanism of injury in this case is unusual and differs from previously reported causes of penetrating abdominal trauma in children. The case demonstrates that penetrating abdominal injuries may be more likely to require surgical intervention secondary to their association with a high percentage of multiple organ injuries. Penetrating injuries in children require a high degree of vigilance to rule out visceral injury.

Angioembolization in intra-abdominal solid organ injury: Does delay in angioembolization affect outcomes?

Angioembolization (AE) is an integral component in multidisciplinary algorithms for achieving hemostasis in patients with trauma. The American College of Surgeons Committee on Trauma recommends that interventional radiologists be available within 30 minutes to perform emergent AE. However, the impact of the timing of AE on patient outcomes is still not well known. We hypothesized that a delay in AE would be associated with increased mortality and higher blood transfusion requirements in patients with blunt intra-abdominal solid organ injury. A 4-year (2013-2016) retrospective review of the ACS Trauma Quality Improvement Program database was performed. We included adult patients (age, ≥18 years) with blunt intra-abdominal solid organ injury who underwent AE within 4 hours of hospital admission. Patients who underwent operative intervention before AE were excluded. The primary outcome was 24-hour mortality. The secondary outcome was blood product transfusions. Patients were grouped into four 1-hour intervals according to their time from admission to AE. Multivariate regression analysis was performed to accommodate patient differences. We analyzed 1,009,922 trauma patients, of which 924 (1 hour, 76; 1-2 hours, 224; 2-3 hours, 350; 3-4 hours, 274) were deemed eligible. The mean ± SD age was 44 ± 19 years, and 66% were male. The mean ± SD time to AE was 144 ± 54 minutes, and 92% of patients underwent AE more than 1 hour after admission. Overall 24-hour mortality was 5.2%. On univariate analysis, patients receiving earlier AE had decreased 24-hour mortality (p = 0.016), but no decrease in blood products transfused. On regression analysis, every hour delay in AE was significantly associated with increased 24-hour mortality (p < 0.05). Delayed AE for hemorrhagic control in blunt trauma patients with an intra-abdominal solid organ injury is associated with increased 24-hour mortality. Trauma centers should ensure timeliness of interventional radiologist availability to prevent a delay in vital AE, and it should be a focus of quality improvement projects. Prognostic, level III.

Evaluation of Adult Abdominal Trauma Patients and Intra Abdominal Solid Organ Injuries

Amaç: Çalışmamızda acil serviste karın yaralanması düşünülüp batın tomografisi çekilen erişkin olguların; demografik özelliklerini, karın yaralanmalarının klinik ve laboratuar bulgularını, travmanın şiddetini, mortalite oranlarını, karın içi solid organ yaralanma oranlarını ve organların yaralanma derecelerini incelemeyi ve literatüre katkıda bulunmayı amaçladık.Yöntem: Bu çalışma acil servise gelen çoklu travma hastalarından batın yaralanması düşünülüp tomografi çekilen 18 yaş üzerindeki 335 hastanın geriye dönük incelenmesi sonucu gerçekleştirildi. Olguların yaşı, cinsiyeti, yaralanma mekanizması, eşlik eden diğer sistem yaralanmaları, vital bulguları, fizik muayene bulguları, laboratuar değerleri, solid organ yaralanma derecesi, olguların yaralanma şiddet skorları, tedavileri ve son durumları kaydedildi. Elde edilen veriler istatistiksel olarak incelendi. Bulgular: Olguların % 76.2 erkekti ve hastaların yaş ortalaması 41±18.4 idi. Batın yaralanması şüphesi olan hastaların %92.8’inde künt yaralanma ve %7.2’sinde ise penetran yaralanma tespit edildi. Tüm hastaların mortalite oranı %1.2 tespit edildi. Hastaların % 12.8’inde solid organ yaralanması mevcuttu. Solid organ yaralanması olan hastaların %95.3’ü künt yaralanma idi. Solid organ yaralanması olan olguların %55.8’inde karaciğer, %41.9’sında dalak, %18.6’sında böbrek yaralanması tespit edildi. Solid organ yaralanması tespit edilen hastaların %79.1’i konservatif tedavi edilirken %20.9’una cerrahi tedavi uygulandı. Solid organ yaralanması olan hastaların yaralanma şiddet skorları (ISS ve NISS) ve transaminaz değerleri anlamlı derecede yüksek bulundu (p&amp;lt;0.05). Sonuç: Sonuç olarak; karın travma olgularında birden fazla karın içi organın yaralanması, eşlik eden karın dışı yaralanmalar, etkilenen solid organın yaralanma derecesi, yüksek travma indeksi mortalite ve morbiditeyi etkileyen faktörler arasında yer almaktadır.

Advantages of early intervention with arterial embolization for intra-abdominal solid organ injuries in children.

Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.

Intra-Abdominal Solid Organ Injury Management in Pediatrics

Abdominal trauma is relatively uncommon in children but can leads to a significant morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children. We are reporting a case of a child with multiple solid organ injury that was successfully treated non-operatively at our center. We presented a previously healthy 9-month-old girl, presented with fluctuating GCS secondary to motor vehicle accident with borderline hemodynamic stability. She was intubated, blood transfusion commenced and a single inotrope support started. She subsequently diagnosed with grade III liver injury, grade II splenic injury, right grade IV renal injury with large perinephric and retroperitoneal hematoma and moderate hemoperitoneum, a non-displaced left superior pubic rami fracture and cerebral edema on computed tomography (CT). She was admitted to pediatric intensive care unit (PICU). Her intra-abdominal injury injuries were successfully treated conservatively. She required a right chest tube on post trauma day 2, for right hemothorax. The chest tube was removed 3 days later following adequate drainage. She eventually was weaned off from ventilator on post trauma day 11. Feeding was commenced on day 7 of post trauma. She was discharge home well after 3 weeks post trauma with periodical follow up. Conclusion: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, which have shown successful rate more than 95%, although continued hemodynamic instability mandates operative intervention.

Evaluation of intra-abdominal solid organ injuries in children.

Aim: In our study we investigated characteristics and degree of intra-abdominal solid organ injuries according to tomographic imaging in pediatric patients who presented to our emergency clinic with possible abdominal injuries and to whom US and/or abdominal tomography were applied. Materials and Methods: 1066 pediatric patients were included in the study. The age, gender, injury localization, injury type, injury mechanism, abdominal US and CT results, and treatment specifics of patients were evaulated. Results:58.5% of cases were male. Average age of children was 7.1±4.6 70.8% of the injuries occured in the outdoors. As for injury type, 92.8% of the injuries were blunt and 7.2% were penetrating traumas. The most common mechanism of injury was motor vehicle accidents at 41.4%. The most common abdominal physical examination finding was tenderness with a prevelance of 67%. In patients with solid organ injury, liver injury was detected in 47% of patients, spleen injury was detected in 36% of patients and renal injury was detected in 17% of patients. Grade II injury was the most common grade. 96.5 of patients were provided conservative treatment and 3.5% of patients were treated surgically. Conclusion: Solid organ injuries due to abdominal trauma in children are generally related to blunt trauma and are severe injuries. CT angio is an important imaging method for detecting solid organ injuries, classification of the injury and treatment determination. Greater than 90% of solid organ injuries in children can be treated successfully with conservative methods. (www.actabiomedica.it)

Management of children with solid organ injuries after blunt torso trauma.

Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%. Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Risk factors of pelvic bone fractures concurrent abdominal solid organ injuries

Objective To evaluate the risk factors of pelvic bone fractures concurrent abdominal solid organ injuries by analyzing the clinical progression of the patients with pelvic bone fractures. Methods The clinical data of 436 patients with pelvic bone fractures were retrieved.Subjects were categorized based on injury types:solid organ versus non-solid organ.The types of injuries, clinical manifestations, treatments, injury severity scores(ISS) and clinical outcomes in the two groups were compared. Results There were 80 patients(18. 3%)subjected to solid organ injury.Fall from height occurred at greater distances(P< 0. 05)in patients that sustained solid organ injuries.The initial blood pressure was lower(P< 0. 05)and the ISS were significantly higher(P< 0. 01)in solid organ injury group.Shock diagnosed immediately upon emergency department arrival(OR ratio= 3. 024,P< 0. 05)and the increased ISS[odds ratio(OR)= 2. 137,P< 0. 05] were the risk factors for intra-abdominal solid organ injuries in trauma patients with pelvic bone fractures. Conclusion For the patients with traumatic pelvic fracture, it will be helpful to judge whether the patient has concurrent abdominal solid organ injuries by investigating the types of injuries, falling height, ISS and initial blood pressure as soon as possible. Key words: Abdominal injuries; Fractures; Pelvic bones

Evaluation of gunshot wounds in the emergency department.

This study aimed to evaluate injury patterns of patients admitted to the emergency department with gunshot wounds, results of imaging studies, treatment modalities, outcomes, mortality ratios, and complications. A retrospective descriptive study was carried out including a total number of one hundred and forty-two patients admitted to Hacettepe University Emergency Department with gunshot injuries between January 1, 1999 and December 31, 2013. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and the Trauma and Injury Severity Score (TRISS) probability of survival for penetrating trauma were calculated for all patients. Among the one hundred and forty-two patients in the study, one hundred and twenty-eight (90.1%) were male. Mean age was 36 years. On admission, the average GCS score was 13, mean RTS was 6.64, median ISS was 5 and median TRISS probability for survival was 99.4% for penetrating trauma. Fluid was detected in three (13%) patients in FAST, whereas intra-abdominal solid organ injury and bowel injury were detected in 11 (58%) patients in abdominal CT. The pneumothorax, hemothorax and lung injuries were detected in 10 (40%) patients, whereas hemothorax was detected only in one patient with thoracic injury by chest X-ray. Twenty four (16.9%) patients died; eighteen patients (75%) had isolated severe intracranial injuries, two (8.3%) had thoracic injuries with head and neck injuries, and four (16.7%) patients had intra-abdominal organ injuries (one with concomitant head injury). Ten patients were brought to the ED in cardiopulmonary arrest. In dead patients, GCS, RTS and TRISS were significantly lower, and ISS were significantly higher than in surviving patients. Twenty three (95.8%) patients were in critical injury level (ISS 25-75, actually ISS >50) in the exitus group. Mortality rates in gunshot wound patients with cranial injuries are very high. Spontaneous return is not seen in patients brought to the ED in arrest state. Bullets can cause internal organ injuries which can be greater than expected. In thoracoabdominal gunshot wound injuries, conventional X-ray and bedside FAST can be ineffective in detecting the whole extent of intrathoracic and intra-abdominal injuries. Thus, thoracic and abdominal CT should be planned early for hemodynamically stable patients in order to eliminate causes of fatality and make a timely and correct diagnosis. ISS, RTS and GCS are useful in predicting prognosis and mortality. Especially in patients with ISS scores >50, the mortality rate can be as high as 96%.

Management of blunt liver trauma in 134 severely injured patients

BackgroundIn haemodynamic stable patients without an acute abdomen, nonoperative management (NOM) of blunt liver injuries (BLI) has become the standard of care with a reported success rate of between 80 and 100%. Concern has been expressed about the potential overuse of NOM and the fact that failed NOM is associated with higher mortality rate. The aim of this study was to evaluate factors that might indicate the need for surgical intervention, and to assess the efficacy of NOM. MethodsA single centre prospective study between 2008 and 2013 in a level-1 Trauma Centre. One hundred thirty four patients with BLI were diagnosed on CT-scan or at laparotomy. The median ISS was 25 (range 16–34). ResultsThirty five (26%) patients underwent an early exploratory laparotomy. The indication for surgery was haemodynamic instability in 11 (31%) patients, an acute abdomen in 16 (46%), and 8 (23%) patients had CT findings of intraabdominal injuries, other than the hepatic injury, that required surgical repair. NOM was initiated in 99 (74%) patients, 36 patients had associated intraabdominal solid organ injuries. Seven patients developed liver related complications. Five (5%) patients required a delayed laparotomy (liver related (3), splenic injury (2)). NOM failure was not related to the presence of shock on admission (p=1000), to the grade of liver injury (p=0.790) or associated intraabdominal injuries (p=0.866). ConclusionPhysiologic behaviour or CT findings dictated the need for operative intervention. NOM of BLI has a high success rate (95%). Nonoperative management of BLI should be considered in patients who respond to resuscitation, irrespective of the grade of liver trauma. Associated intraabdominal solid organ injuries do not exclude NOM.

Abdominal solid organ injury in trauma patients with pelvic bone fractures.

We analyzed the clinical progression of trauma patients with pelvic bone fractures so to determine the risk factors associated with sustaining concurrent abdominal solid organ injuries. This study was a retrospective chart review. Subjects were categorized based on injury type: solid organ versus non-solid organ injury groups. These study groups were compared based on demographics, treatments, and clinical outcomes. Potential risk factors that may contribute to the occurrence of abdominal solid organ injury in trauma patients with pelvic bone fractures were evaluated. The solid organ injury group included 17.4% of all the patients in the study (n=69). Fall from height occurred at greater distances in patients that sustained solid organ injuries as opposed to patients with non-solid organ injuries. Initial blood pressure and Revised Trauma Scores were lower in the solid organ injury group. Shock diagnosed immediately upon emergency department arrival was a risk factor for intra-abdominal solid organ injuries in trauma patients with pelvic bone fractures. Clinical prognosis for patients in the solid organ injury group was poorer and more invasive treatments were performed for patients in this group. Traumatic pelvic fracture patient prognosis needs to be improved through early diagnosis and prompt delivery of aggressive treatments based on rapid identification of abdominal solid organ injuries.

Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes

Pediatric obesity is associated with lower-extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared with those of nonobese patients. We performed a retrospective cohort study of obese and nonobese pediatric patients with femur or tibia fractures treated at two Level I trauma centers from 2004 to 2010. Patients weighing 95th percentile or greater for age and sex were classified as obese. Patients were compared regarding demographics, Injury Severity Score (ISS), as well as intra-abdominal and orthopedic injuries. Outcomes included fracture treatment, orthopedic complications, intensive care unit and hospital length of stay, ventilator days, and mortality. Of the 356 patients included in the study, 78 (21.9%) were obese and 278 (78.1%) were nonobese. Obese patients were older (mean [SD], 9.9 [3.7] years vs. 8.8 [3.9] years; p = 0.0162), had a higher ISS (20.8 [13.4] vs. 14.5 [10.8]; p = 0.0002), and sustained more intra-abdominal solid organ (24.4% vs.13.5%; p = 0.0200) and hollow viscus (3.9% vs. 0.0%; p = 0.0105) injuries. They had more pelvic fractures (15.4% vs. 6.9%; p = 0.0196), bilateral tibia fractures (8.0% vs. 0.0%; p = 0.0332), and operatively treated femur fractures (89.9% vs. 79.1%; p = 0.0484). Adjusting for age, obese patients were more likely to be admitted to the intensive care unit (relative risk, 1.68; 95% confidence interval, 1.10-2.55) and die in the hospital (relative risk, 3.45; 95% confidence interval, 1.14-10.41). Adjusting for ISS, these associations were nonsignificant. Obese patients with femur and tibia fractures have more severe injuries, which may predispose them to greater inpatient morbidity and mortality than do nonobese patients. Epidemiologic study, level III.

The Double Jeopardy of Blunt Thoracoabdominal Trauma

To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma. Trauma registry and medical record review. Level I trauma center in Los Angeles, California. All patients with thoracoabdominal injuries from January 1996 to December 2010. Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality. Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality. Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.

Combat-Related Pelvis Fractures in Nonsurvivors

The purpose of this study was to describe pelvic fractures and their associated injuries in service members who either died of wounds or were killed in action during Operation Iraqi Freedom and Operation Enduring Freedom and define any differences in associated injuries between penetrating versus blunt injury to the pelvis. A review of all service members who sustained a pelvis fracture during Operation Iraqi Freedom and Operation Enduring Freedom in the year 2008 was performed. Data were recorded for analysis. One hundred four nonsurvivors were identified with pelvic fractures. Appropriate records, photos, and radiographs were available for 91, 70 were classified as "Not Survivable" (77%) and 21 "Potentially Survivable" (23%). Mechanisms of injury included 69 blast (76%), 14 gunshot wounds (15%), 4 motor vehicle accidents (4.5%), and 4 "other" (4.5%). Direct injury to the pelvis was penetrating in 60 (66%) and blunt in 31 (34%). Large pelvic vessel injury was observed more frequently in penetrating pelvic injuries (27%) than blunt injuries (3%). Hollow viscus abdominal injuries were more common in those with penetrating (57%) than blunt injuries (10%). There was an inverse relationship with intra-abdominal, solid organ injuries (blunt, 81%; penetrating, 55%). Head injuries were also more common in blunt pelvic injuries (blunt, 68%; penetrating, 45%), as were cardiopulmonary injuries (blunt, 84%, penetrating injuries, 57%). Large pelvic vessel and hollow viscus injuries occur more frequently in penetrating combat-related pelvic fractures, whereas intra-abdominal solid organ, head, and cardiopulmonary injuries are more common in blunt pelvic injuries.

Predictors of Mortality in Blunt Multi-Trauma Patients: A Retrospective Review

PurposeThe purpose of this study was to identify risk factors predicting mortality in multiple blunt trauma patients so as to prompt appropriate management during trauma resuscitation.MethodTo assess risk factors potentially related to mortality in multiple blunt trauma patients, we reviewed the medical records of 1419 multiple blunt trauma patients who were admitted to the emergency department. The patients were divided into two groups; the survival group (n=1308) and the death group (n=111). Initial data collected on arrival in the emergency department were analyzed.ResultsIn the study, 67.4% (n=956) of 1419 patients were male, 32.6% (n=463) were female. The average age was 21.19±0.50 years (range 1-92). After controlling for the factors significantly related to outcome (all p&lt;0.05), death due to multiple blunt trauma was more likely in patients who were of older age, who had major chest injury, who had intra-abdominal solid organ injury and who had low Glasgow Coma Scale (GCS) score and low Revised Trauma Score (RTS).ConclusionWe conclude that older age, major chest injury, intra-abdominal solid organ injury, low GCS and low RTS were identified as possible risk factors for mortality in multiple blunt trauma patients.

Intra-Abdominal Solid Organ Injury in Children: Diagnosis and Treatment

Abdominal trauma is relatively uncommon in children but can be the source of significant morbidity and mortality. The diagnosis and treatment of blunt abdominal injury to the solid organs were examined, and the differences between children and adults were highlighted. The PubMed database was used to identify the relevant literature. Additional source material was identified through referenced articles. Identification of injury to the solid organs in children depends on a high index of suspicion, abnormal physical examination findings, and the judicious use of laboratory and imaging studies. Although abdominal and pelvic computed tomography with intravenous contrast remains the gold standard for imaging, it does expose children to a significant dose of radiation. Currently, more than 90% of solid organ injuries in children are treated nonoperatively. Abnormal hemodynamics, however, suggests active bleeding and requires operative intervention. Accurate diagnosis of the organ injured and degree of injury are important considerations for "return to play" decisions. The management of pancreatic ductal injuries is somewhat controversial, although the distal spleen preserving pancreatectomy is frequently the technique of choice. Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, although continued hemodynamic instability mandates operative intervention.

Current Trends in the Management of Blunt Solid Organ Injuries.

The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

Selective Nonoperative Management of Low-Grade Blunt Pancreatic Injury: Are We There Yet?

Nonoperative management (NOM) of low-grade blunt pancreatic injuries (LGBPI) diagnosed by computed tomographic (CT) abnormalities of the pancreas in the adult hemodynamically stable (HDS) patient has not been previously defined. We report our experience of patients with LGBPI at a single Level I Trauma Center. Adult HDS patients during a 5-year period with blunt pancreatic injuries with an abbreviated injury score of </=2 were identified through the hospital trauma registry. Management, complications, and outcome were reviewed. Patients who underwent initial emergency laparotomy, died on hospital day one, or had a Glasgow Coma Scale of three were excluded. Failure of NOM was defined by need for subsequent exploratory laparotomy or development of a pancreatic complication. Data are reported as mean +/- SEM. A total of 120 patients were identified as having blunt pancreatic injury of which 35, with pancreatic abbreviated injury score of </=2, were blunt HDS patients with abdominal CT evidence of pancreatic injury. Amylase elevation was noted in 23 of 35 (68.5%) patients with positive CT scan findings of LGBPI. Study population consisted of 20 male patients and 15 female patients, age 32 +/- 13.22, injury severity score 21 +/- 10.08, systolic pressure 123 +/- 27.06 with mean base deficit -3.78 +/- 2. Of these 12 (34.28%) patients had an associated intra-abdominal solid organ injury. Five patients failed NOM (F-NOM), one had missed small bowel injury, three had pancreatic abscess, of which one developed a pancreatic fistula which resolved with medical management, and one F-NOM for blunt liver injury with missed bowel injury. No death in the F-NOM group and two deaths (5.71%) in the successful NOM (S-NOM) group unrelated to the pancreas. The average length of stay was 11 days +/- 9.71 days. NOM of LGBPI diagnosed by CT was successful in the majority of HDS patients, with low morbidity and mortality. We propose a management algorithm for NOM of LGBPI in which the role for early ductal injury detection with endoscopic retrograde cholangio-pancreatogram or magnetic retrograde cholangio-pancreatogram should be incorporated to better analyze the most appropriate treatment.