Noninvasive management strategy in hemodynamically unstable patients with blunt trauma.
BACKGROUND
Non-operative management in abdominal injuries may reduce non-therapeutic laparatomies without increasing mortality. The aim of this study is to evaluate the results of a recently used non-invasive management strategy, in trauma patients in our institution.


METHODS
A retrospective chart review was performed. The sixty-three patients (50 males; 13 females; range 8 to 61 years) with abdominal injuries who were unstable during their admissions to our institution between July 1st, 2000 and July 1st, 2001 (the first year of the NIMS implementation) were identified and divided into three groups according to the presence or absence of surgical intervention and the timing of the operation.


RESULTS
There were 63 blunt abdominal trauma patients who were unstable during admission. Patients in Group 1 (n=14) and Group 2 (n=10) had urgent laparotomy during the resuscitation therapy or after a median observation period of 7 hours (range, 2 to 20). Group 3 patients (n=39) did not require surgical intervention.


CONCLUSIONS
Most of the trauma patients who respond to initial fluid replacement do not require surgery. Close monitoring and repeated abdominal examinations (NIMS) can be the main criteria for surgical intervention, although they are not the most reliable techniques in the diagnosis of solid organ injuries in all patients and of hollow organ injuries in conscious patients.
Gezen
F Cem
FC
1st Department of General Surgery Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey. cemgezen@hotmail.com
Cinçin
Tarik G
TG
Oncel
Mustafa
M
Vural
Selahattin
S
Erdemir
Ayhan
A
Dalkiliç
Gülay
G
Menteş
Cengiz
C
Tüzün
Bariş
B
D000007:Abdominal Injuries / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010533:Peritoneal Lavage; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014421:Turkey / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*