Trauma Organ Injury Scale Research Articles

Angioembolization in patients with blunt splenic trauma in Germany –guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®

PurposeNonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany.MethodsBetween 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room.ResultsA total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%.ConclusionsIn this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.

Contemporary management and outcomes of blunt traumatic American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries in children: A Trauma Quality Improvement Program analysis.

The Trauma Quality Improvement Program (TQIP) database has delineated management strategies and outcomes for adults with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries and suggests that nonoperative management (NOM) is a viable option for these injuries. However, management strategies vary for children following significant pancreatic injuries and outcomes for these intermediate/high-grade injuries have not been sufficiently studied. Our aim was to describe the management and outcomes for grades III and IV pancreatic injuries using TQIP. We hypothesize that pediatric patients with intermediate/high-grade injuries can be safely managed with NOM. All pediatric patients (younger than 18 years) registered in TQIP between 2013 and 2021 who suffered a grade III or IV pancreatic injury due to blunt trauma were included in the current study. Patient demographics, clinical characteristics, complications, and in-hospital mortality were compared between the different treatment strategies for pancreatic injury: NOM versus drainage and/or pancreatic resection. A total of 580 patients meeting the inclusion criteria were identified. A total of 416 pediatric patients suffered a grade III pancreatic injury; 79% (n = 332) were NOM, 7% (n = 27) received a drain, and 14% (n = 57) underwent a pancreatic resection. A further 164 patients suffered a grade IV pancreatic injury; 77% (n = 126) were NOM, 11% (n = 18) received a drain, and 12% (n = 20) underwent a pancreatic resection. No differences in overall injury severity or demographical data were observed between the treatment groups. No difference in in-hospital mortality was detected between the different management strategies. Patients who received a drain had a longer hospital length of stay. The majority of children with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries are managed nonoperatively. Nonoperative management is a reasonable strategy for these injuries and results in equivalent in-hospital adverse outcome profiles as pancreatic drainage or resection with a shorter hospital length of stay. Therapeutic/Care Management; Level IV.

Splenic artery embolization in the treatment of blunt splenic injury: single level 1 trauma center experience.

To describe the experience of a single level 1 trauma center in the management of blunt splenic injuries (BSI). This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with P < 0.05 considered statistically significant. The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (P > 0.05). Distal embolization with Gelfoam® had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, P > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam® (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (P > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (P > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam® and coil embolization (P > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (P = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (P = 0.04, P = 0.01). The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam® was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation. Distal splenic embolization with Gelfoam® is safe and may be beneficial in the setting of blunt splenic trauma.

Out with the old, in with the new? The revised AAST grading schema better predicts splenic salvage but not splenectomy

BackgroundThe revised American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) for splenic injury incorporates radiologic features but the implications of this are unknown. We hypothesized that the revised AAST-OIS would better predict outcomes. MethodsPatients with a blunt splenic injury admitted to a Level I trauma center were reviewed from 2016 to 2021. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for splenectomy were calculated for high-grade injuries (AAST-OIS grades IV-V) using both schemas. ResultsOf the 852 patients analyzed, 48.5% were observed, 24.6% were embolized, and the remaining underwent operative intervention. The median AAST-OIS increased from II to III (p ​< ​0.01). Sensitivity (38.0% vs. 73.7%) and NPV (80.9% vs. 88.2%) for splenectomy increased for high-grade injuries but specificity (93.5% vs 70.1%) and PPV (67.5% vs 46.7%) decreased. ConclusionThe revised AAST-OIS better predicted splenic salvage but is less accurate at predicting need for splenectomy.

Lack of Concordance Between Abbreviated Injury Scale and American Association for the Surgery of Trauma Organ Injury Scale in Patients with High-Grade Solid Organ Injury.

The Abbreviated Injury Scale (AIS) is widely used for body region-specific injury severity. The American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) provides organ-specific injury severity but is not included in trauma databases. Previous researchers have used AIS as a surrogate for OIS. This study aims to assess AIS-abdomen concordance with AAST-OIS grade for liver and spleen injuries, hypothesizing concordance in terms of severity (grade of OIS and AIS) and patient outcomes. This retrospective study (July 2020 to June 2022) was performed at 3 trauma centers. Adult trauma patients with AAST-OIS grade III to V liver and spleen injury were included. AAST-OIS grade for each organ was compared with AIS-abdomen by evaluating the percentage of AAST-OIS grade correlating with each AIS score as well as rates of operative intervention for these injuries. Analysis was performed with chi-square tests and univariate analysis. Of 472 patients, 274 had liver injuries and 205 had spleen injuries grades III to V. AAST-OIS grade III to V liver injuries had concordances rates of 85.5%, 71%, and 90.9% with corresponding AIS 3 to 5 scores. AAST-OIS grade III to V spleen injuries had concordances rates of 89.7%, 87.8%, and 87.3%, respectively. There was a statistical lack of concordance for both liver and spleen injuries (both p < 0.001). Additionally, there were higher rates of operative intervention for AAST-OIS grade IV and V liver injuries and grade III and V spleen injuries vs corresponding AIS scores (p < 0.05). AIS should not be used interchangeably with OIS due to lack of concordance. AAST-OIS should be included in trauma databases to facilitate improved organ injury research and quality improvement projects.

Proposed revision of the American Association for Surgery of Trauma Renal Organ Injury Scale: Secondary analysis of the Multi-institutional Genitourinary Trauma Study.

This study updates the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention. This was a secondary analysis of a multicenter retrospective study including patients with high-grade renal trauma from seven level 1 trauma centers from 2013 to 2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed-effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST OIS. Based on the 2018 OIS grading system, we included 549 patients with AAST grades III to V injuries and computed tomography scans (III, 52% [n = 284]; IV, 45% [n = 249]; and V, 3% [n = 16]). Among these patients, 89% experienced blunt injury (n = 491), and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded, and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from grade IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC, 0.805; revised AUC, 0.883; p = 0.001) and number of units of packed red blood cells transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention. A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system. Diagnostic Test/Criteria; Level III.

The Role of Dual-Energy CT in Solid Organ Injury.

The liver, spleen, and kidneys are the commonest injured solid organs in blunt and penetrating trauma. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted system for categorizing traumatic injuries. Grading systems allow clear communication of findings between clinical teams and assign a measurable severity of injury, which directly correlates with morbidity and mortality. The 2018 revised AAST OIS emphasizes reliance on CT for accurate grading; in particular regarding vascular injuries. Dual-Energy CT (DECT) has emerged as a promising tool with multiple clinical applications already demonstrated. In this review article, we summarize the basic principles of CT attenuation to refresh the minds of our readers and we scrutinize DECT's technology as opposed to conventional Single-Energy CT (SECT). This is followed by outlining the benefits of various DECT postprocessing techniques, which authors of this article refer to as the 3Ms (Mapping of Iodine, Material decomposition, and Monoenergetic virtual imaging), in aiding radiologists to confidently assign an OIS as well as problem solve complex injury patterns. In addition, a thorough discussion of changes to the revised AAST OIS focusing on definitions of key terms used in reporting injuries is described.

Paediatric blunt abdominal trauma with organ injury: a comprehensive analysis of cases at a tertiary hospital in Bangladesh

Background: Pediatric blunt abdominal trauma with organ injuries is a critical issue in Bangladesh, lacking sufficient research. This study focuses on managing such cases in a tertiary hospital. Objectives were to assess clinical characteristics, injury patterns, and outcomes of pediatric patients with blunt abdominal trauma and organ injuries. It aims to identify causes, associated injuries, and hospital stay durations. Methods: A prospective study of 142 pediatric patients aged 1-12 was conducted at Rajshahi medical college hospital study period January 2020 to December 2021. In addition, this study aimed to identify and grade solid organ injuries according to the American association for the surgery of trauma organ injury scale. Results: Prevalence of hepatic injuries (76.8%), solid organ injuries (90.1%), road traffic accidents (71.8%), falls from height (25.4%). Most received conservative treatment, had short hospital stays, and a 7% mortality rate. Gender had no significant impact on organ injuries (p&gt;0.001). Among the causes, 84.5% had hepatic injuries, 15.5% had spleen injuries due to road traffic accidents, and 58.3% had injuries from falls from height, with a highly significant cause-organ injury relationship (p&lt;0.001). Conclusions: pediatric blunt abdominal injuries in Bangladesh affect various organs, primarily in males and school-aged children, primarily due to road accidents. Timely surgical intervention and preventive measures are crucial for improved outcomes.

Grading Abdominal Trauma: Changes in and Implications of the Revised 2018 AAST-OIS for the Spleen, Liver, and Kidney.

According to the Centers for Disease Control and Prevention, trauma is the leading cause of fatal injuries for Americans aged 1-44 years old and the fourth leading overall cause of death. Accurate and early diagnosis, including grading of solid organ injuries after blunt abdominal trauma (BAT), is crucial to guide management and improve outcomes. The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) is the most widely accepted BAT scoring system at CT both within the United States and internationally, and its uses include stratification of injury severity, thereby guiding management, and facilitation of clinical research, billing, and coding. Furthermore, this system also plays a role in the credentialing process for trauma centers in the United States. The newly revised 2018 OIS provides criteria for grading solid organ damage into three groups: imaging, operation, and pathology. The final grade is based on the highest of the three criteria. If multiple lower-grade (I or II) injuries are present in a single organ, one grade is advanced to grade III. The most substantial change in the revised 2018 AAST-OIS is incorporation of multidetector CT findings of vascular injury, including pseudoaneurysm and arteriovenous fistula. The authors outline the main revised aspects of grading organ injury using the AAST-OIS for the spleen, liver, and kidney after BAT, particularly the role of multidetector CT and alternative imaging in organ injury detection, the importance of vascular injuries in grade change, and the impact of these changes on patient management and in prediction of operative treatment success and in-hospital mortality. ©RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.

Pancreatic and Duodenal Injuries: Experience at A Single Trauma Centre

Background: Pancreatic and duodenal injuries are uncommon due to relative protection by their posterior anatomical position and have an incidence of less than 1% of all hospital admissions for trauma. Auckland City Hospital is a tertiary referral hospital in New Zealand with Trauma and Hepatopancreatobiliary units and admits approximately 384 patients with major trauma per year, predominantly from blunt mechanisms. This study is used to assess the incidence, diagnosis and clinical management of pancreatic and duodenal injuries in trauma patients at a single trauma centre. Method: A retrospective study was undertaken using data from a prospectively collected trauma registry. Inpatient notes including all patients admitted from 2007 to 2020 were reviewed. Pancreatic and duodenal injuries were graded using the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) grading system. Investigations including radiology and biochemistry and clinical management were noted. Results: A total of 45 trauma patients admitted to Auckland City Hospital had sustained pancreatic or duodenal injuries. Six patients had combined pancreaticoduodenal injuries, 16 had duodenal and 23 had pancreatic injuries. Grade I organ injuries were the most common in pancreatic (19/29) and duodenal injuries (9/22). Majority of patients underwent laparotomy (33/45) for associated haemodynamic instability. All organ specific indications for surgery occurred in Grade II and higher injuries. 10/45 patients were managed non-operatively, of which the majority had Grade I or II organ injuries (9/45). 3/45 patients died. Conclusion: The incidence of pancreaticoduodenal injuries is rare (45 patients in 13 years) and in keeping with trauma literature. In our series, haemodynamically stable patients with Grade I - II pancreatic and Grade I - II (non-laceration type) duodenal injuries did not require operative management. Endoscopic pancreatic stenting may facilitate selective non-operative management in some patients with pancreatic injury or complications.

Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury?

To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P=.01). Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.

Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy-An Ancillary Study.

The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.

The American Association for the Surgery of Trauma Organ Injury Scale for Spleen Does Not Equally Predict Interventions in Penetrating and Blunt Trauma.

The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the spleen (and other organs) was created in 1989. It has been validated to predict mortality, need for operation, length of stay (LOS), and intensive care unit (ICU) LOS. We aimed to determine if the Spleen OIS is applied equally to blunt and penetrating trauma. We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017-2019, including patients with spleen injuries. Outcomes included the rates of mortality, operation, spleen-specific operation, splenectomy, and splenic embolization. 60900 patients had a spleen injury with an OIS grade. Mortality rates increased in Grades IV and V for both blunt and penetrating trauma. In blunt trauma, the odds for any operation, spleen-specific operation, and splenectomy increased, for each increase in grade. Penetrating trauma showed similar trends in grades up to grade IV, but were statistically similar between grade IV and V. Splenectomy was higher in penetrating trauma for all grades. Splenic embolization peaked at 25% of grade IV trauma before decreasing in grade V. Rates in penetrating trauma were significantly lower in all grades, peaking at 2.5% of Grade III injuries. The mechanism of trauma is a significant factor for all outcomes, independent of AAST-OIS. Hemostasis is predominantly surgical in penetrating trauma, achieved with angioembolization more frequently in blunt trauma. Penetrating trauma management is influenced by the potential for injury to peri-splenic organs.

Splenic Artery Embolization in Conservative Management of Blunt Splenic Injury Graded by 2018 AAST-OIS: Results from a Hospital in Vietnam.

This study was conducted to evaluate the results of conservative management of blunt splenic trauma according to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) in 2018 by embolization. This observational study included 50 patients (42 men and 8 women) with splenic injury who underwent multidetector computed tomography (MDCT) and embolization. According to the 2018 AAST-OIS, 27 cases had higher grades than they did according to the 1994 AAST-OIS. The grades of two cases of grade II increased to grade IV; those of 15 cases of grade III increased to grade IV; and four cases of grade IV increased to grade V. As a result, all patients underwent successful splenic embolization and were stable at discharge. No patients required re-embolization or conversion to splenectomy. The mean hospital stay was 11.8±7 days (range, 6-44 days), with no difference in length of hospital stay among grades of splenic injury (p >0.05). Compared with the AAST-OIS 1994, the AAST-OIS 2018 classification is useful in making embolization decisions, regardless of the degree of blunt splenic injury with vascular lacerations visible on MDCT.

Validating the American Association for the Surgery of Trauma Pancreas Injury Grade Using Trauma Quality Improvement Program Data.

The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the pancreas was created in 1990. Our aim was to validate the ability of the AAST-OIS pancreas grade to predict adjuncts to operative management, including endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drain placement. We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019, including all patients with a pancreas injury. Outcomes included the rates of mortality, laparotomy, ERCP, and peri-pancreatic or hepatobiliary percutaneous drain placement. Outcomes were analyzed by AAST-OIS, and odds ratios (ORs) and 95 confidence intervals (CIs) were calculated for each. 3571 patients were included in the analysis. The AAST grade was associated with increased rates of mortality and laparotomy at every level (P < .05). Endoscopic retrograde cholangiopancreatography rates increased from grade 2 to 3 (OR 4.685, 95% CI 3.254-6.745), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .443, CI .250-.788). Likewise, rates of percutaneous drain placement increased from grade 2 to 3 (OR 1.999, CI 1.192-3.353), were similar between grades 3 and 4 (P > .05), and decreased from grades 4 to 5 (OR .266, .076-.934). Increasing pancreatic injury grade is associated with increased mortality and laparotomy rates at all levels. Endoscopic retrograde cholangiopancreatography and percutaneous drainage procedures are used most in mid-grade (3-4) pancreatic trauma. The decrease in nonsurgical procedures in grade 5 pancreatic trauma is likely secondary to increased rates of surgical management (resection and/or wide drainage). The AAST-OIS for pancreatic injury is associated with mortality and interventions.

The American Association for the Surgery of Trauma Organ Injury Scale is Associated With Cystoscopic and Percutaneous Urologic Procedures in Renal Injuries.

The American Association for the Surgery of Trauma Organ Injury Scale for the kidney was created in 1989. It has been validated to various outcomes including operations. It was updated in 2018 to better predict endourologic interventions, but this change has not been validated. In addition, the AAST-OIS does not consider mechanism of trauma in its interpretation. We analyzed 3years of the Trauma Quality Improvement Program database including all patients with a kidney injury. We recorded rates of mortality, operation, renal operation, nephrectomy, renal embolization, cystoscopic intervention, and percutaneous urologic procedures. 26294 patients were included. In penetrating trauma, mortality, operation, renal-specific operation, and nephrectomy rates increased at every grade. Renal embolization and cystoscopy rates peaked in grade IV. Percutaneous interventions were rare across all grades. In blunt trauma, mortality and nephrectomy rates increased only in grades IV and V. Operation, renal operation, and renal embolization rates increased at every grade level. Cystoscopy rates peaked in grade IV. Percutaneous procedure rates only increased between grades III and IV. Penetrating injuries are more likely to require nephrectomy in grades III-V, cystoscopic procedures in grade III, and percutaneous procedures in grades I-III. Endourologic procedures are most utilized in grade IV injuries, which are in part defined by injuries with damage to the central collecting system. Despite penetrating injuries more frequently requiring nephrectomy, they also more frequently require nonsurgical procedures. Mechanism of trauma should be considered when interpreting the AAST-OIS for kidney injuries.

ROLE OF 128 SLICE MDCT IN PANCREATIC TRAUMA DIAGNOSIS AND MANAGEMENT

Aims and Objectives:This study aimed to detail how multi-detector computed tomography (MDCT) can be utilised to the study diagnosis of pancreatic trauma and its management. Material and Methods:This Hospital-based prospective study was carried out over 10 months from December 2020 to SEP 2021 at the Department of Radiodiagnosis, Narayana medical college, Nellore. 30 patients with pancreatic injury were included in study. All patients underwent Contrast enhanced computed tomography abdomen on128 slice CT(GE OPTIMA 660).Grading of pancreatic injury done using American Association for the surgery of trauma organ injury scale .One patient underwent MRI abdomen and MRCP. 20 patients are treated conservatively. 10 out of 30 patients underwentsurgery.Intraoperative findings noted. Results: 1. According to American Association for the surgery of trauma organ injury scale 19/30 patients are of grade I &amp;grade II injury. 6/30 in grade III and 5/30 were grade IV injuries. 2. Grade I &amp;II patients were managed conservatively and improved remarkably on followup. 3. Grade III&amp;IV patients underwent surgery and CT findings are confirmed intraoperatively. 4. 6 patients with grade III injury undergone Distal pancreatectomy + Splenectomy and 4 patients undergone Spleen preserving Distal Pancreatectomy. 5. Grade IV patients initially managed conservatively in which 4 patients developed pseudocyst they were treated with cystogastrostomy and one patient developed fistula .This fistula was initially controlled with Percutaneous catheter drainage followed by roux -en- y fistulojejunostomy. Conclusion: 1. CT represents an accurate tool for diagnosing pancreatic trauma, it provides useful information to plan therapeutic approach .

Management Strategies and Outcomes of Paediatric Blunt Abdominal Trauma at a Tertiary Care Centre in South Kerala: A Retrospective Observational Study

Introduction: Blunt abdominal trauma is a leading cause of injury in paediatric population. The management of paediatric abdominal injury has shifted from Operative Management (OM) to Non Operative Management (NOM) over years. NOM is the standard treatment for clinically stable patients with blunt trauma abdomen. Aim: To describe retrospectively the management strategies and outcomes of paediatric patients with blunt abdominal trauma in a tertiary care centre. Materials and Methods: This was a retrospective observational record-based study that included 96 medical records of children admitted in Government Medical College, Thiruvananthapuram, Kerala, India, with blunt trauma abdomen from January 2018 to December 2022. Patients were characterised according to the treatment they received as- NOM and OM. Ultrasound Focused Assessment with Sonography in Trauma (USG FAST) and Contrast Enhanced Computed Tomography (CECT) abdomen were done in all the patients. The factors recorded were- age, gender, mechanism of injury, concomitant injury, tachycardia, hypotension, respiratory rate, blood transfusion requirement, injuries (American Association of Surgery of Trauma (AAST) organ injury scale), length of Intensive Care Unit (ICU) and hospital stay and mortality. Univariate analysis of the clinical features were done using Chi-square test using Statistical Package for the Social Sciences (SPSS) 27.0 statistical software. The p-value &lt;0.05 was considered statistically significant. Result: About 83 patients (86.46%) were in NOM group while 13 patients (13.54%) were in OM group. The most common age group involved was 6-12 years with male predominance. Median age was 9.2 years. The most common mechanism of injury was road traffic accident 31 (32.29%). Among 84 patients with isolated solid organ injury, only 5 (5.9%) required surgical intervention. Among nine patients with isolated hollow viscous injury, 5 (55.5%) required surgical intervention. All 3 (100%) patients with both hollow viscous and solid organ injury required surgery. Hypotension and blood transfusion requirement were statistically significant factors in the OM group p&lt;0.05. Complications, length of hospital and ICU stay were more in operatively managed group with mortality rate of 1.04%. Conclusion: The success of NOM of blunt trauma abdomen depends on proper selection of the patient. Patients who are haemodynamically stable can be safely managed non operatively with adequate monitoring in a tertiary care centre.

Operative Management of Penetrating Colon Injury: Gone Are the Days of the Diverting Colostomy

INTRODUCTION: There is continued controversy regarding the optimal operative management of penetrating colon injury (PCI). The aim of our study is to compare outcomes of initial diverting operation (DO) vs primary repair and anastomosis (PRA) for PCI. METHODS: A 2017-2018 American College of Surgeons TQIP analysis. All adult trauma patients with operatively managed PCI were included. Transferred, dead ≤24 hours, or burn patients were excluded. Patients were stratified into DO or PRA. Outcomes measures were superficial and deep operative site infection (SSI) rate, intraabdominal abscess, sepsis, infectious complication, and failure of operative management (FOM; unplanned operating room return or subsequent diversion), hospital and ICU length of stay (LOS), and mortality. Multivariate regression was performed to identify predictors of infectious complication. RESULTS: A total of 4,504 patients were identified, of whom 357 (8%) underwent DO and 4,147 (92%) PRA. Mean age was 34 ± 13 years, 4,029(90%) were men, median Injury Severity Score was 16 [9-25]. The most common mechanism of injury was firearm (82%). Left-sided colon was most commonly affected (38%), and 56% had an American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade III PCI or higher. A total of 599b(13%) patients had an infectious complication. DO group had higher superficial SSI rate (5.0% vs 2.4%; p = 0.003) and infectious complication (19.0% v s12.8%; p < 0.001), but no difference in deep SSI rate, intra-abdominal abscess, sepsis, FOM, mortality, hospital and ICU LOS between both groups (p > 0.05). Independent predictors of infectious complication are described in the Table. CONCLUSION: One in 7 patients with PCI developed an infectious complication, most commonly an intra-abdominal abscess. DO is independently associated with increased risk of infectious complication, along with left-sided PCI, concomitant gastric or small intestinal injuries, firearm injury, and AAST-OIS grade of PCI. PRA should be the preferred operative management for PCI.Table

Management of pancreatic trauma-a single center experience

Background: Traumatic injury to the pancreas is rare and frequently overlooked. High index of suspicion is required in diagnosing pancreatic injury and management is challenging even with experienced trauma surgeons. The aim of this study was to report our experience in the management of pancreatic injuries.Methods: We analyzed 39 patients with pancreatic injury managed in our center from January 2016- December 2021. Data regarding patients’ demographics, mode of injury, American association for the surgery of trauma-organ injury scale (AAST-OIS) grade of pancreatic injury, associated injuries, management, morbidity and mortality were collected for analysis.Results: The study included 39 patients who presented with blunt injury abdomen (AAST-OIS grading: grade 2 (n=6), grade 3 (n=29), grade 4 (n=4)) with mean age 28.9 years. Associated injuries were present in 41% of patients (n=16). Thirteen patients had non-operative management-5 of them were managed conservatively without any intervention; 8 of them had non-surgical intervention in the form of Percutaneous Drainage or Endoscopic Retrograde Cholangio Pancreatography with Pancreatic duct stent for peri-pancreatic collection or ductal injury. But the rate of readmission for recurrent pancreatitis and reintervention for peri-pancreatic collection was 46% and 38% respectively in these patients. Twenty-six patients underwent surgery-distal pancreato splenectomy, laparotomy and external drainage, Roux-en Y pancreaticojejunostomy.Conclusions: Management of high-grade pancreatic injuries needs technical expertise. Early diagnosis and appropriate surgical management in high-grade pancreatic injuries carries favorable outcomes. Delayed presentation with sepsis is associated with high mortality.