Blunt pancreatoduodenal injury: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).
OBJECTIVE
To evaluate the safety of nonoperative management (NOM), to examine the diagnostic sensitivity of computed tomography (CT), and to identify missed diagnoses and related outcomes in patients with blunt pancreatoduodenal injury (BPDI).


METHODS
Retrospective multicenter study.


METHODS
Eleven New England trauma centers (7 academic and 4 nonacademic).


METHODS
Two hundred thirty patients (>15 years old) with BPDI admitted to the hospital during 11 years. Each BPDI was graded from 1 (lowest) to 5 (highest) according to the American Association for the Surgery of Trauma grading system.


METHODS
Success of NOM, sensitivity of CT, BPDI-related complications, length of hospital stay, and mortality.


RESULTS
Ninety-seven patients (42.2%) with mostly grades 1 and 2 BPDI were selected for NOM: NOM failed in 10 (10.3%), 10 (10.3%) developed BPDI-related complications (3 in patients in whom NOM failed), and 7 (7.2%) died (none related to failure of NOM). The remaining 133 patients were operated on urgently: 34 (25.6%) developed BPDI-related complications and 20 (15.0%) died. The initial CT missed BPDI in 30 patients (13.0%); 4 of them (13.3%) died but not because of the BPDI. The mortality rate in patients without a missed diagnosis was 8.8% (P = .50). There was no correlation between time to diagnosis and length of hospital stay (Spearman r = 0.06; P = .43). The sensitivity of CT for BPDI was 75.7% (76% for pancreatic and 70% for duodenal injuries).


CONCLUSIONS
The NOM of low-grade BPDI is safe despite occasional failures. Missed diagnosis of BPDI continues to occur despite advances in CT but does not seem to cause adverse outcomes in most patients.
Velmahos
George C
GC
Departments of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. gvelmahos@partners.org
Tabbara
Malek
M
Gross
Ronald
R
Willette
Paul
P
Hirsch
Erwin
E
Burke
Peter
P
Emhoff
Timothy
T
Gupta
Rajan
R
Winchell
Robert J
RJ
Patterson
Lisa A
LA
Manon-Matos
Yorrell
Y
Alam
Hasan B
HB
Rosenblatt
Michael
M
Hurst
James
J
Brotman
Sheldon
S
Crookes
Bruce
B
Sartorelli
Kennith
K
Chang
Yuchiao
Y
D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*