Trauma surgeons practice what they preach: The NTDB story on solid organ injury management.
BACKGROUND
Recent studies advocate a nonoperative approach for hepatic and splenic trauma. The purpose of this study was to determine whether the literature has impacted surgical practice and, if so, whether or not the overall mortality of these injuries had changed.


METHODS
The American College of Surgeons' National Trauma Data Bank (NTDB 4.0) was analyzed using trauma admission dates ranging from 1994 to 2003. All hepatic and splenic injuries were identified by ICD-9 codes. As renal trauma management has not changed during the study period, renal injuries were included as a control. Nonoperative management (NOM) rates and overall mortality were determined for each organ. Proportions were compared using chi analysis with significance set at p < 0.05.


RESULTS
There were 87,237 solid abdominal organ injuries reported and included: 35,767 splenic, 35,510 hepatic, 15,960 renal injuries. There was a significant (p < 0.00000000005) increase in percentage of NOM for hepatic and splenic trauma whereas renal NOM remained stable for the study period. Despite an increase in NOM for splenic and hepatic injuries, mortality has remained unchanged.


CONCLUSIONS
This study demonstrates that the management of hepatic and splenic injuries has significantly changed in the past 10 years with no appreciable effect on mortality. NOM has become the standard of care for the management of hepatic and splenic trauma. The NTDB can be used to monitor changes in trauma care in response to new knowledge regarding improved outcomes.
Hurtuk
Michael
M
Department of Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Reed
R Lawrence
RL
Esposito
Thomas J
TJ
Davis
Kimberly A
KA
Luchette
Fred A
FA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D013502:General Surgery / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000293:injuries; D008099:Liver / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D015996:Survival Rate; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000628:therapy