title: A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury.
abstract: BACKGROUND
  Hollow viscus injuries (HVI) are uncommon after blunt trauma, and accomplishing a timely diagnosis can be difficult. Time to operative intervention has been implicated as a risk factor for mortality, but reports are conflicting.
  
  
  METHODS
  All blunt trauma admissions to an academic level 1 trauma center from January 1992 to September 2005 were retrospectively reviewed. Patients with a diagnosis of blunt HVI were included. Patients who died within 24 hours were excluded. Data regarding patient demographics, injuries, time from admission until laparotomy, length of stay, and mortality were recorded, and a multivariate analysis to determine independent risk factors for mortality was carried out. A p < 0.05 was considered significant.
  
  
  RESULTS
  Of 35,033 blunt trauma admissions, there were 195 (0.6%) HVI patients with the following characteristics (data expressed as mean +/- 1 SD): mean age of 35 years +/- 16 years, Injury Severity Score of 17 +/- 11, time from admission to laparotomy of 5.9 hours +/- 5.8 hours, operative blood loss of 1500 mL +/- 1800 mL, and length of stay of 19 days +/- 23 days. Twelve percent presented with a systolic pressure <90 mm Hg and 9% died. Independent risk factors for mortality were age (odds ratio [OR] = 1.04, p = 0.005), Abdominal Abbreviated Injury Score (OR = 2.5, p = 0.011), the presence of a significant extra-abdominal injury (OR = 3.4, p = 0.043), and a delay of more than 5 hours between admission and laparotomy (OR = 3.2, p = 0.0499). Eighty-six percent of the deaths in patients who had a delay of >5 hours were because of abdominal-related sepsis.
  
  
  CONCLUSIONS
  HVI occurred in less than 1% of all blunt trauma admissions. Delays in operative intervention are associated with an increased mortality. A high index of suspicion is needed to make a timely diagnosis and minimize risk.
authors.affiliation: Department of Surgery, University of California, Irvine, California 92868, USA. malinosd@uci.edu
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Didem Oncel
authors.initials: DO
authors.lastname: Yakar
authors.forename: Donald
authors.initials: D
authors.lastname: Green
authors.forename: Faisal
authors.initials: F
authors.lastname: Qureshi
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000367:Age Factors; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery