Sten Saar1,2, Joakim Jorgensen3,4, Aurora N Lemma4, Christine Gaarder3,4, Pal A Naess3,4, Ari Leppäniemi5, Ville Sallinen5, Riinu Pius6, Arvo Reinsoo7,8, Jaak Lepp7, Peep Talving8,9. 1. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia. stensaars@gmail.com. 2. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia. stensaars@gmail.com. 3. Department of Traumatology, Oslo University Hospital, Oslo, Norway. 4. Faculty of Medicine, University of Oslo, Oslo, Norway. 5. Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland. 6. The University of Edinburgh, Edinburgh, Scotland. 7. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia. 8. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia. 9. North Estonia Medical Centre, Tallinn, Estonia.
Abstract
PURPOSE: A selective nonoperative management (SNOM) of penetrating abdominal injuries (PAI) is a standard of care in numerous established trauma centers. However, available evidence supporting SNOM of PAI in European settings remains scarce. Thus, we performed a multi-center study at selected Northern European trauma centers to investigate the management and outcomes of PAI. We hypothesized that despite a low number of penetrating injuries in included trauma centers, SNOM is successfully utilized with outcomes comparable with trauma centers with a high number of PAI. METHODS: All adult patients admitted to participating trauma centers in the Northern European region with PAI between 1/2015 and 12/2016 were retrospectively reviewed. Primary outcomes were mortality and success rate of SNOM. RESULTS: Overall, 119 patients were included. Median age was 38 (28-47) years. SNOM was initiated in 55 patients (46.0%) with 94.5% success rate. Three patients (5.5%) failed SNOM and had a delayed laparotomy with one gastric injury, one small bowel injury and one patient with a bleeding from mesentery. Overall mortality of the cohort was 5.0%. However, all patients in the SNOM group survived. Higher median ISS, median Abbreviated Injury Scale score of the abdomen, rate of combined anterior and posterior wounds, rate of in-hospital complications and longer hospital length of stay were observed in the immediate laparotomy group compared to the SNOM group. CONCLUSIONS: SNOM of PAI is a safe practice even in regions with a low prevalence of penetrating injuries. The outcomes in our study are comparable with results from trauma centers treating larger numbers of patients with PAI.
PURPOSE: A selective nonoperative management (SNOM) of penetrating abdominal injuries (PAI) is a standard of care in numerous established trauma centers. However, available evidence supporting SNOM of PAI in European settings remains scarce. Thus, we performed a multi-center study at selected Northern European trauma centers to investigate the management and outcomes of PAI. We hypothesized that despite a low number of penetrating injuries in included trauma centers, SNOM is successfully utilized with outcomes comparable with trauma centers with a high number of PAI. METHODS: All adult patients admitted to participating trauma centers in the Northern European region with PAI between 1/2015 and 12/2016 were retrospectively reviewed. Primary outcomes were mortality and success rate of SNOM. RESULTS: Overall, 119 patients were included. Median age was 38 (28-47) years. SNOM was initiated in 55 patients (46.0%) with 94.5% success rate. Three patients (5.5%) failed SNOM and had a delayed laparotomy with one gastric injury, one small bowel injury and one patient with a bleeding from mesentery. Overall mortality of the cohort was 5.0%. However, all patients in the SNOM group survived. Higher median ISS, median Abbreviated Injury Scale score of the abdomen, rate of combined anterior and posterior wounds, rate of in-hospital complications and longer hospital length of stay were observed in the immediate laparotomy group compared to the SNOM group. CONCLUSIONS: SNOM of PAI is a safe practice even in regions with a low prevalence of penetrating injuries. The outcomes in our study are comparable with results from trauma centers treating larger numbers of patients with PAI.
Authors: Jakob Mejdahl Bentin; Emma Possfelt-Møller; Peter Svenningsen; Søren Steemann Rudolph; Martin Sillesen Journal: Scand J Trauma Resusc Emerg Med Date: 2022-07-08 Impact factor: 3.803