title: An analysis of predictors of morbidity after stab wounds of the pancreas in 78 consecutive injuries.
abstract: BACKGROUND
  Penetrating injuries of the pancreas may result in serious complications. This study assessed the factors influencing morbidity after stab wounds of the pancreas.
  
  
  METHODS
  A retrospective univariate cohort analysis was carried out of 78 patients (74 men) with a median age of 26 years (range: 16-62 years) with stab wounds of the pancreas between 1982 and 2011.
  
  
  RESULTS
  The median revised trauma score (RTS) was 7.8 (range: 2.0-7.8). Injuries involved the body (n=36), tail (n=24), head/uncinate process (n=16) and neck (n=2) of the pancreas. All 78 patients underwent a laparotomy. Sixty-five patients had AAST (American Association for the Surgery of Trauma) grade I or II pancreatic injuries and thirteen had grade III, IV or V injuries. Eight patients (10.3%) had an initial damage control operation. Sixty-nine patients (84.6%) had drainage of the pancreas only, six had a distal pancreatectomy and one had a pancreaticoduodenectomy. Most pancreas related complications occurred in patients with AAST grade III injuries; eight patients (10.2%) developed a pancreatic fistula. Four patients (5.1%) died. Grade of pancreatic injury (AAST grade I-II vs grade III-V injuries, p<0.001), RTS (odds ratio [OR]: 5.01, 95% confidence interval [CI]: 1.46-17.19, p<0.007), presence of shock on admission (OR: 3.31, 95% CI: 1.16-9.42, p=0.022), need for a blood transfusion (OR: 6.46, 95% CI: 2.40-17.40, p<0.001) and repeat laparotomy (p<0.001) had a significant influence on the development of general complications.
  
  
  CONCLUSIONS
  Although mortality was low after a pancreatic stab wound, morbidity was high. Increasing AAST grade of injury, high RTS, shock on admission to hospital, need for blood transfusion and repeat laparotomy were significant factors related to morbidity.
authors.affiliation: Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: J E J
authors.initials: JE
authors.lastname: Krige
authors.forename: U K
authors.initials: UK
authors.lastname: Kotze
authors.forename: R
authors.initials: R
authors.lastname: Sayed
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009104:Multiple Trauma / Q000473:pathology; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D057772:Vascular System Injuries / Q000473:pathology; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult