Non-operative management of blunt abdominal solid organ trauma in adult patients
Introduction: Despite agreement in the literature that “stable” blunt trauma patients may be managed conservatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP)...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X20300173 |
| _version_ | 1828848716769918976 |
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| author | Wesam Ibrahim Gamal Mousa Jon Mark Hirshon Mohamed El-Shinawi Hani Mowafi |
| author_facet | Wesam Ibrahim Gamal Mousa Jon Mark Hirshon Mohamed El-Shinawi Hani Mowafi |
| author_sort | Wesam Ibrahim |
| collection | DOAJ |
| description | Introduction: Despite agreement in the literature that “stable” blunt trauma patients may be managed conservatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP) management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta University Emergency Hospital (TUH) in Egypt. Methods: A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ injury at TUH over a 3-year period (June 2014–June 2017). Inclusion criteria were age ≥18 yr, mean arterial pressure >65 mm Hg, heart rate <110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; patients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All patients were assigned to non-operative or operative management based on clinician preference. Outcomes of interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ2 were used to compare outcomes. Results: During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10 – NOP vs. 28 ± 11 – OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP] vs.1155.17 ± 380.4 ml [OP] (p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs. 6.45 ± 1.97 days [OP] (p = 0.012)). There was no difference in mortality between groups (p = 0.091). Conclusion: Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer length of stay for non-operative patients might reflect treating physician caution in their management. |
| first_indexed | 2024-12-12T22:34:51Z |
| format | Article |
| id | doaj.art-2bb0a8c5c16449d3b5b6d8078dbf3aa1 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-12-12T22:34:51Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-2bb0a8c5c16449d3b5b6d8078dbf3aa12022-12-22T00:09:29ZengElsevierAfrican Journal of Emergency Medicine2211-419X2020-09-01103123126Non-operative management of blunt abdominal solid organ trauma in adult patientsWesam Ibrahim0Gamal Mousa1Jon Mark Hirshon2Mohamed El-Shinawi3Hani Mowafi4Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt; Corresponding author.Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, EgyptDepartment of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USADepartment of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, EgyptDepartment of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USAIntroduction: Despite agreement in the literature that “stable” blunt trauma patients may be managed conservatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP) management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta University Emergency Hospital (TUH) in Egypt. Methods: A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ injury at TUH over a 3-year period (June 2014–June 2017). Inclusion criteria were age ≥18 yr, mean arterial pressure >65 mm Hg, heart rate <110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; patients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All patients were assigned to non-operative or operative management based on clinician preference. Outcomes of interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ2 were used to compare outcomes. Results: During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10 – NOP vs. 28 ± 11 – OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP] vs.1155.17 ± 380.4 ml [OP] (p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs. 6.45 ± 1.97 days [OP] (p = 0.012)). There was no difference in mortality between groups (p = 0.091). Conclusion: Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer length of stay for non-operative patients might reflect treating physician caution in their management.http://www.sciencedirect.com/science/article/pii/S2211419X20300173Blunt abdominal traumaOperativeNon-operative managementSolid organs |
| spellingShingle | Wesam Ibrahim Gamal Mousa Jon Mark Hirshon Mohamed El-Shinawi Hani Mowafi Non-operative management of blunt abdominal solid organ trauma in adult patients African Journal of Emergency Medicine Blunt abdominal trauma Operative Non-operative management Solid organs |
| title | Non-operative management of blunt abdominal solid organ trauma in adult patients |
| title_full | Non-operative management of blunt abdominal solid organ trauma in adult patients |
| title_fullStr | Non-operative management of blunt abdominal solid organ trauma in adult patients |
| title_full_unstemmed | Non-operative management of blunt abdominal solid organ trauma in adult patients |
| title_short | Non-operative management of blunt abdominal solid organ trauma in adult patients |
| title_sort | non operative management of blunt abdominal solid organ trauma in adult patients |
| topic | Blunt abdominal trauma Operative Non-operative management Solid organs |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X20300173 |
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