Non-operative management of blunt abdominal solid organ trauma in adult patients

ABSTRACT

Introduction: Despite agreement in the literature that"stable"blunt trauma patients may be managed con-servatively, in Egypt many such patients receive operative management. This paper presents the results of apragmatic, 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 TantaUniversity Emergency Hospital (TUH) in Egypt.Methods:A prospective observational study enrolled adult blunt abdominal trauma patients with solid organinjury at TUH over a 3-year period (June 2014­June 2017). Inclusion criteria were age≥18 yr, mean arterialpressure > 65 mm Hg, heart rate < 110 bpm, hematocrit≥7 mg/dl, and abdominal organ injury diagnosed byultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-tients were assigned to non-operative or operative management based on clinician preference. Outcomes ofinterest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics andχ2wereused to compare outcomes. Results:During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominaltrauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10­NOP vs. 28 ± 11­OP,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 wassafe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longerlength of stay for non-operative patients might reflect treating physician caution in their management