title: Multiplicity of solid organ injury: influence on management and outcomes after blunt abdominal trauma.
abstract: OBJECTIVE
  The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes.
  
  
  METHODS
  This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95% confidence intervals.
  
  
  RESULTS
  Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69% (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8% (53 of 915) in group S and 11.6% (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B.
  
  
  CONCLUSIONS
  Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.
authors.affiliation: Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, 23298, USA. akmalhot@hsc.vcu.edu
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
authors.forename: S
authors.initials: S
authors.lastname: Dhage
authors.forename: Tiffany K
authors.initials: TK
authors.lastname: Bee
authors.forename: Preston R
authors.initials: PR
authors.lastname: Miller
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Jay A
authors.initials: JA
authors.lastname: Yelon
mesh_terms: D000007:Abdominal Injuries / Q000145:classification / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000401:mortality / Q000601:surgery / Q000628:therapy*