title: Abdominal injuries in a major Scandinavian trauma center - performance assessment over an 8 year period.
abstract: BACKGROUND
  Damage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period.
  
  
  METHODS
  Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared.
  
  
  RESULTS
  There was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period.
  
  
  CONCLUSIONS
  Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM.
authors.affiliation: Department of Traumatology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Nydalen, PO Box 4956, Oslo N-0424, Norway ; Department of Surgery, Vestre Viken HF Drammen Hospital, Oslo, Norway.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Groven
authors.affiliation: Department of Traumatology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Nydalen, PO Box 4956, Oslo N-0424, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.affiliation: Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway.
authors.forename: Torsten
authors.initials: T
authors.lastname: Eken
authors.affiliation: Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway.
authors.forename: Nils Oddvar
authors.initials: NO
authors.lastname: Skaga
authors.affiliation: Department of Traumatology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Nydalen, PO Box 4956, Oslo N-0424, Norway.
authors.forename: Paal Aksel
authors.initials: PA
authors.lastname: Naess
keywords: Abdominal injury; Laparotomy; Non-operative management; Performance improvement; Survival; Trauma; Variable life-adjusted display
references.citation: J Trauma. 2003 Jan;54(1):161-3
references.pmid: 12544912
references.citation: J Surg Res. 2010 Oct;163(2):179-85
references.pmid: 20708750
references.citation: J Trauma. 2004 Jan;56(1):7-12
references.pmid: 14749559
references.citation: J Trauma. 2003 Jan;54(1):1-7; discussion 7-8
references.pmid: 12544893
references.citation: J Trauma. 2007 Jun;62(6):1421-6
references.pmid: 17563659
references.citation: J Trauma. 1990 Nov;30(11):1356-65
references.pmid: 2231804
references.citation: Injury. 2005 Nov;36(11):1288-92
references.pmid: 16122752
references.citation: J Trauma. 2010 Nov;69(5):1011-21
references.pmid: 21068605
references.citation: J Trauma. 2005 Mar;58(3):425-36
references.pmid: 15761333
references.citation: J Trauma. 2003 May;54(5):829-33; discussion 833-4
references.pmid: 12777895
references.citation: J Trauma. 2000 Mar;48(3):408-14; discussion 414-5
references.pmid: 10744277
references.citation: J Trauma. 2003 Feb;54(2):289-94
references.pmid: 12579054
references.citation: J Trauma. 1996 Jan;40(1):31-8
references.pmid: 8576995
references.citation: Injury. 2008 May;39(5):612-22
references.pmid: 18377909
references.citation: J Trauma. 2005 Apr;58(4):663-7
references.pmid: 15824640
references.citation: Injury. 2007 Sep;38(9):1075-83
references.pmid: 17706220
references.citation: Am Surg. 1998 Jun;64(6):552-6; discussion 556-7
references.pmid: 9619177
references.citation: Am Surg. 2009 Jul;75(7):558-63; discussion 563-4
references.pmid: 19655598
references.citation: J Trauma. 1978 Oct;18(10):701-5
references.pmid: 702606
references.citation: J Trauma Acute Care Surg. 2012 Dec;73(6):1500-6
references.pmid: 23188243
references.citation: J Trauma. 2006 Jul;61(1):192-8
references.pmid: 16832270
references.citation: J Trauma. 2000 Aug;49(2):177-87; discussion 187-9
references.pmid: 10963527
references.citation: J Trauma. 2000 Nov;49(5):969-78
references.pmid: 11086798
references.citation: J Trauma. 2008 Nov;65(5):1007-11
references.pmid: 19001966
references.citation: J Trauma. 2011 Mar;70(3):569-74
references.pmid: 21610344
references.citation: J Trauma. 2001 Oct;51(4):633-7; discussion 637-8
references.pmid: 11586151
references.citation: Lancet. 1997 Oct 18;350(9085):1128-30
references.pmid: 9343500
references.citation: J Trauma. 2010 Jul;69(1):46-52
references.pmid: 20622577
references.citation: Am J Surg. 1995 Oct;170(4):333-40
references.pmid: 7573724
references.citation: J Trauma. 2001 Jun;50(6):1015-9
references.pmid: 11426114
references.citation: J Trauma. 2010 Jul;69(1):84-7
references.pmid: 20622582