Laparotomy for trauma in a regional centre: the effect of delay on outcome.
From 1983 to 1990, 110 patients with abdominal trauma required laparotomy in the Albury-Wodonga region. Splenic and liver injuries occurred in 50% of cases, and bowel trauma in 20%. The mortality rate was 8.2% (nine deaths) and major postoperative complications occurred in 18 patients (16%). Delay in therapeutic intervention of greater than 4 h from hospital admission led to a statistically significant increase in the complication rate (P < 0.01) despite a lower injury severity score in this group. Delayed repair of bowel injuries in particular led to an 80% major complication rate in survivors. A high index of clinical suspicion and the regular use of diagnostic peritoneal lavage is suggested to avoid such delays in diagnosis and subsequent surgery.
Royal Melbourne Hospital, Parkville, Australia.
B T
BT
Stewart
V
V
Lee
P D
PD
Danne
D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000058:Accidental Falls; D000063:Accidents, Traffic; D005260:Female; D006780:Hospitals, Rural / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000293:injuries / Q000601:surgery; D007813:Laparotomy / Q000592:standards / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013154:Spleen / Q000293:injuries / Q000601:surgery; D013156:Splenectomy; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery; D014951:Wounds, Stab / Q000601:surgery