Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.
OBJECTIVE
Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI.


METHODS
Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient.


RESULTS
A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score was 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries.


CONCLUSIONS
Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.
Fakhry
S M
SM
Trauma Services, Inova Regional Trauma Center at Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
Brownstein
M
M
Watts
D D
DD
Baker
C C
CC
Oller
D
D
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D007421:Intestine, Small / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery