ABSTRACT
Objectives: To identify the predictive factors of successful non-operative management of patients with intraperitoneal bleeding following blunt abdominal trauma
Methods: This was cross-sectional study being performed in our Level I trauma center in southern Iran between 2010 and 2011. We included adult [>14 years] patients with blunt abdominal trauma and intraperitoneal hemorrhage detected by CT-Scan who were hemodynamically stable and did not require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative management failure [NOM-F] while the other were nonoperative management success [NOM-S]. The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding
Results: Overall we included 80 eligible patients among whom there were 55 [68.7%] men and 25 [31.3%] women with mean age of 30.63.6 +/- years. Finally, 43 [53.8%] were successfully managed conservatively [NOM-S] while 37 [46.2%] required laparotomy [NOM-F]. We found that those who underwent emergency laparotomy had significantly higher [delta]Hb [p=0.016] and lower base deficit [p=0.005] when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure [p<0.001] and higher shock index [p=0.002]. The other parameters such as pulse rate and respiratory rate were comparable between two study groups
Conclusion: In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative management are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission