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. 2009 May 13:17:22.
doi: 10.1186/1757-7241-17-22.

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

George A Giannopoulos  1 , Iraklis E Katsoulis, Nikolaos E Tzanakis, Panayotis A Patsaouras, Michalis K Digalakis
Affiliations

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

George A Giannopoulos et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: 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.

Methods: Prospective 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).

Results: NOM 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.

Conclusion: According 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.

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Figures

Figure 1
Figure 1
Organ-specific severity of injury in NOM group. Note that a patient may have injury in more than one organ.
See this image and copyright information in PMC

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