title: Outcomes of hemodynamically stable patients with pancreatic injury after blunt abdominal trauma.
abstract: BACKGROUND
  To date there is no systematical report about blunt pancreatic injury focused on hemodynamically stable patients. This study reports on our experience in this rare subgroup at a tertiary referral hospital.
  
  
  METHODS
  A total of 58 adult patients were identified during a 10-year period and their clinical data were analyzed. Injury to the main pancreatic duct (MPD) was basically confirmed by pancreatography or surgical findings.
  
  
  RESULTS
  MPD disruption was confirmed in 36 patients (62%) and was more frequent in the pancreatic neck and body. The median time from trauma to confirmation was 14 days [interquartile range (IQR) 3-23 days] including time from admission to confirmation of 10.5 days [IQR 3-20 days]. Patients with MPD injury showed higher injury severity score, more frequent pancreas-specific complications and longer hospital stays. The sensitivity and specificity of initial computed tomography (CT) for MPD injury were 63.9% (23/36) and 81.8% (18/22), respectively. The mortality rate was 7%, and all deaths were directly attributed to pancreatic injury. Complications occurred in 22 patients (37%) and 17 developed during hospitalization. Time from trauma to confirmation of MPD disruption (odds ratio 1.132; 95% confidence interval 1.021-1.255, P=0.019) was the only independent factor associated with unfavorable events among patients with high-grade injury.
  
  
  CONCLUSIONS
  MPD injury was not infrequent in hemodynamically stable patients. Physicians were more responsible for the delay in diagnosis of MPD disruption, which was primarily associated with adverse outcomes. A rapid, multidisciplinary approach may lead to better outcomes in hemodynamically stable patients with blunt pancreatic injury.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Pil Hyung
authors.initials: PH
authors.lastname: Lee
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Gwang Un
authors.initials: GU
authors.lastname: Kim
authors.forename: Suk-Kyung
authors.initials: SK
authors.lastname: Hong
authors.forename: Jin-Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Yil-Sik
authors.initials: YS
authors.lastname: Hyun
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010183:Pancreatic Ducts / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*