title: Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma.
abstract: OBJECTIVE
  Intestinal perforation due to blunt abdominal trauma is rarely seen in children and delayed diagnosis is a major concern. Because the potential risk factors affecting morbidity are not well known, we evaluated whether diagnostic delay increases morbidity in gastrointestinal perforation from blunt abdominal trauma in children.
  
  
  METHODS
  Twenty-nine children with gastrointestinal perforation caused by blunt abdominal trauma, admitted to our clinic between 1983 and 2001, were retrospectively evaluated by analyzing the relationship between overall morbidity and potential risk factors.
  
  
  RESULTS
  There were 23 boys and 6 girls. Most of the injuries were caused by falls and motor vehicle accidents. The jejunum was the most frequent site of perforation followed by the ileum. Simple closure was the most common surgical procedure. Postoperative complications developed in five patients (17%) and included wound infections in two, wound dehiscence in one, and adhesive small bowel obstruction in two. Potential risk factors such as trauma mechanism, the presence of shock on admission, and associated organ injury were not significantly correlated with postoperative complications, whereas a period of delay exceeding 8 h and an Injury Severity Score (ISS) exceeding 15 were significantly related to septic complications (P < 0.05). The relative risk of a septic complication developing was higher than 2 for the following risk factors: a fall from a flat-roofed house and a time delay before operative intervention. There were three deaths (10%) in this series, caused by sepsis in two patients and head injury in one.
  
  
  CONCLUSIONS
  These findings suggest that rapid diagnosis and treatment is important for preventing complications in patients with intestinal perforation caused by blunt abdominal trauma. A delay exceeding 8 h and an ISS score exceeding 15 were related to significant septic complications, and falls from flat-roofed houses are an important public safety risk in Turkey.
authors.affiliation: Department of Pediatric Surgery, Dicle University Medical School, 21280 Diyarbakir, Turkey.
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Oztürk
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Onen
authors.forename: Selçuk
authors.initials: S
authors.lastname: Otçu
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Dokucu
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yağmur
authors.forename: Mete
authors.initials: M
authors.lastname: Kaya
authors.forename: Selçuk
authors.initials: S
authors.lastname: Yücesan
mesh_terms: D000007:Abdominal Injuries / Q000150:complications*; D000058:Accidental Falls; D000063:Accidents, Traffic; D002648:Child; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology; D015601:Injury Severity Score; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D014946:Wound Infection / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications*