A Diagnostic Delay of 5 Hours Increases the Risk of Death After Blunt Hollow Viscus Injury

Malinoski, Darren; Patel, Madhukar S.; Yakar, Didem Oncel; Green, Donald P.; Qureshi, Faisal; Inaba, Kenji; Brown, Carlos V R; Salim, Ali

doi:10.1097/ta.0b013e3181db37f5

Cited by 94 publications

(77 citation statements)

References 6 publications

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“…Delays in diagnosis of as much as 8 h [21], or in one study 5 h [6] is responsible for increased morbidity and mortality in patients with bowel and mesenteric injury. However, Thompson et al [22] report no such findings in a study of 13 children out of which 09 were because of motor vehicular accidents.…”

Section: Discussionmentioning

confidence: 99%

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Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.

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Section: Discussionmentioning

confidence: 99%

“…A delay in diagnosis and hence treatment increases morbidity and mortality [4,5]. In fact, one recent study has demonstrated an association between increased morbidity and mortality with a delay as brief as 5 h in the surgical treatment of small bowel injury [6].…”

Section: Introductionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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“…Overall, BAT patients constitute a poorly understood group in terms of definitions, management [8][9][10][11][12] and initial imaging characteristics, 13 especially in the new trauma environment in the UK, following the recent service reconfigurations. The aim of this study was to build a profile for BAT patients presenting to a regional group of major trauma centres in terms of their characteristics and outcomes for immediate or delayed laparotomy.…”

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confidence: 99%

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Pande

Saratzis

Beatty

et al. 2017

annals

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INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.

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“…Patients previously transferred to their local hospital at an earlier stage could be kept in the trauma center when deemed beneficial in order to optimize care. NOM for blunt trauma might lead to delayed diagnosis and treatment of hollow viscus injury, and such delays have been associated with increased mortality [29-32]. In spite of the high NOM rate in our material, the rate of missed injuries remained low throughout the study period.…”

Section: Discussionmentioning

confidence: 74%

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Groven

Gaarder

Eken

et al. 2014

J Trauma Manage Outcomes

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IntroductionDamage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period.MethodsData from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared.ResultsThere was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period.ConclusionEven in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM.

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A Diagnostic Delay of 5 Hours Increases the Risk of Death After Blunt Hollow Viscus Injury

Abstract: HVI occurred in less than 1% of all blunt trauma admissions. Delays in operative intervention are associated with an increased mortality. A high index of suspicion is needed to make a timely diagnosis and minimize risk.

Cited by 94 publications

References 6 publications

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

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