Mesenteric injuries after blunt abdominal trauma: delay in diagnosis and increased morbidity.
Mesenteric injuries after blunt abdominal trauma are infrequent and difficult to diagnose. We investigated whether a delay in diagnosis of more than 6 hours had a significant impact on morbidity, mortality, and length of stay at our Level I trauma center. A retrospective chart review spanning the period from January 1995 to September 2005 identified 85 patients with laparotomy-confirmed mesenteric injuries, 81 of whom survived to hospital discharge. Nineteen (23%) of the 81 patients had a delay in diagnosis of greater than 6 hours. After controlling for identified confounders, we found that the delayed diagnosis group experienced 30 per cent longer hospital stays (P = 0.03), 55 per cent longer intensive care unit stays (P = 0.006), and 38 per cent longer duration of mechanical ventilation (P = 0.05). Patients in the delayed group also had significantly higher odds of developing acute respiratory distress syndrome, as well as trends toward higher odds of wound infection, pneumonia, multiple organ dysfunction syndrome, abdominal compartment syndrome, renal failure, and ileus. No significant difference in mortality was observed among all 85 patients (P = 0.67). Thus, in contradiction to some previous studies, our review indicates that a delay in the diagnosis of mesenteric injuries results in significantly increased morbidity and hospital and intensive care unit lengths of stay.
Shebrain
Saad
S
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
Zelada
Juliette
J
Lipsky
Ari M
AM
Putnam
Brant
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000209:etiology; D015986:Confounding Factors, Epidemiologic; D003422:Critical Care; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D015601:Injury Severity Score; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008643:Mesentery / Q000293:injuries*; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis