Jason A London1, Lisa Parry, Joseph Galante, Felix Battistella. 1. Division of Trauma and Emergency Surgery, Department of Surgery, University of California, Davis, 2315 Stockton Blvd, Ste 4207, Sacramento, CA 95817, USA. Jason.london@ucdmc.ucdavis.edu
Abstract
BACKGROUND: Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. OBJECTIVE: To determine whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries. DESIGN: Retrospective cohort study. Univariate and multivariate analyses were performed to determine the association of mobilization with delayed hemorrhage of a solid organ requiring laparotomy. SETTING: Level I trauma center. PATIENTS: Adults with blunt renal, hepatic, or splenic injuries were identified from a trauma registry. MAIN OUTCOME MEASURES: Medical records were used to determine the day of mobilization and to identify patients with delayed hemorrhage requiring laparotomy. RESULTS: Four hundred fifty-four patients with blunt solid organ injuries were admitted to the hospital for nonoperative management. Failure rates of nonoperative management were 4.0%, 1.0%, and 7.1% for renal, hepatic, and splenic injuries, respectively. No patients with renal or hepatic injuries failed secondary to delayed hemorrhage. Ten patients (5.5%) with splenic injuries failed secondary to delayed hemorrhage. Eighty-four percent of patients with renal injuries, 80% with hepatic injuries, and 77% with splenic injuries were mobilized within 72 hours of admission. Day of mobilization was not associated with delayed splenic rupture in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.90-1.05). CONCLUSIONS: The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.
BACKGROUND: Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. OBJECTIVE: To determine whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries. DESIGN: Retrospective cohort study. Univariate and multivariate analyses were performed to determine the association of mobilization with delayed hemorrhage of a solid organ requiring laparotomy. SETTING: Level I trauma center. PATIENTS: Adults with blunt renal, hepatic, or splenic injuries were identified from a trauma registry. MAIN OUTCOME MEASURES: Medical records were used to determine the day of mobilization and to identify patients with delayed hemorrhage requiring laparotomy. RESULTS: Four hundred fifty-four patients with blunt solid organ injuries were admitted to the hospital for nonoperative management. Failure rates of nonoperative management were 4.0%, 1.0%, and 7.1% for renal, hepatic, and splenic injuries, respectively. No patients with renal or hepatic injuries failed secondary to delayed hemorrhage. Ten patients (5.5%) with splenic injuries failed secondary to delayed hemorrhage. Eighty-four percent of patients with renal injuries, 80% with hepatic injuries, and 77% with splenic injuries were mobilized within 72 hours of admission. Day of mobilization was not associated with delayed splenic rupture in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.90-1.05). CONCLUSIONS: The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165
Authors: Mircea Beuran; Ionuţ Nego; Alexandru Teodor Ispas; Softin Păun; Alexandru Runcanu; Giorgica Lupu; Dan Venter Journal: J Med Life Date: 2010 Jul-Sep