Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?
BACKGROUND
To evaluate the feasibility and safety of non-operative management (NOM) of blunt abdominal trauma in a district general hospital with middle volume trauma case load.


METHODS
Prospective protocol-driven study including 30 consecutive patients who have been treated in our Department during a 30-month-period. Demographic, medical and trauma characteristics, type of treatment and outcome were examined. Patients were divided in 3 groups: those who underwent immediate laparotomy (OP group), those who had a successful NOM (NOM-S group) and those with a NOM failure (NOM-F group).


RESULTS
NOM was applied in 73.3% (22 patients) of all blunt abdominal injuries with a failure rate of 13.6% (3 patients). Injury severity score (ISS), admission hematocrit, hemodynamic status and need for transfusion were significantly different between NOM and OP group. NOM failure occurred mainly in patients with splenic trauma.


CONCLUSIONS
According to our experience, the hemodynamically stable or easily stabilized trauma patient can be admitted in a non-ICU ward with the provision of close monitoring. Splenic injury, especially with multiple-site free intra-abdominal fluid in abdominal computed tomography, carries a high risk for NOM failure. In this series, the main criterion for a laparotomy in a NOM patient was hemodynamic deterioration after a second rapid fluid load.
1st Surgical Department, Asklepieion Voulas General Hospital, Athens, Greece. geogianno@hotmail.com
George A
GA
Giannopoulos
Iraklis E
IE
Katsoulis
Nikolaos E
NE
Tzanakis
Panayotis A
PA
Patsaouras
Michalis K
MK
Digalakis
D000007:Abdominal Injuries / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006115:Greece; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012449:Safety; D014949:Wounds, Nonpenetrating / Q000628:therapy*; D055815:Young Adult