Multiplicity of solid organ injury: Influence on management and outcomes after blunt abdominal trauma

Ajai K. Malhotra, Rifat - Latifi, Timothy C. Fabian, Rao R. Ivatury, S. Dhage, Tiffany K. Bee, Preston R. Miller, Martin A. Croce, Jay A. Yelon

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective: The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes. Methods. This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95% confidence intervals. Results: Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69% (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8% (53 of 915) in group S and 11.6% (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B. Conclusion: Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.

Original languageEnglish (US)
Pages (from-to)925-929
Number of pages5
JournalJournal of Trauma
Volume54
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Wounds and Injuries
Spleen
Liver
Length of Stay
Injury Severity Score
Blood Pressure
Mortality
Trauma Centers
Intensive Care Units
Lactic Acid
Confidence Intervals
Hemorrhage
Therapeutics

Keywords

  • Blunt abdominal trauma
  • Liver
  • Multiple injuries
  • Nonoperative management
  • Outcomes
  • Solid organ injury
  • Spleen

ASJC Scopus subject areas

  • Surgery

Cite this

Multiplicity of solid organ injury : Influence on management and outcomes after blunt abdominal trauma. / Malhotra, Ajai K.; Latifi, Rifat -; Fabian, Timothy C.; Ivatury, Rao R.; Dhage, S.; Bee, Tiffany K.; Miller, Preston R.; Croce, Martin A.; Yelon, Jay A.

In: Journal of Trauma, Vol. 54, No. 5, 01.05.2003, p. 925-929.

Research output: Contribution to journalArticle

Malhotra, AK, Latifi, R, Fabian, TC, Ivatury, RR, Dhage, S, Bee, TK, Miller, PR, Croce, MA & Yelon, JA 2003, 'Multiplicity of solid organ injury: Influence on management and outcomes after blunt abdominal trauma', Journal of Trauma, vol. 54, no. 5, pp. 925-929. https://doi.org/10.1097/01.TA.0000066182.67385.86
Malhotra, Ajai K. ; Latifi, Rifat - ; Fabian, Timothy C. ; Ivatury, Rao R. ; Dhage, S. ; Bee, Tiffany K. ; Miller, Preston R. ; Croce, Martin A. ; Yelon, Jay A. / Multiplicity of solid organ injury : Influence on management and outcomes after blunt abdominal trauma. In: Journal of Trauma. 2003 ; Vol. 54, No. 5. pp. 925-929.
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abstract = "Objective: The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes. Methods. This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95{\%} confidence intervals. Results: Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69{\%} (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8{\%} (53 of 915) in group S and 11.6{\%} (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B. Conclusion: Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.",
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AU - Dhage, S.

AU - Bee, Tiffany K.

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AB - Objective: The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes. Methods. This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95% confidence intervals. Results: Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69% (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8% (53 of 915) in group S and 11.6% (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B. Conclusion: Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.

KW - Blunt abdominal trauma

KW - Liver

KW - Multiple injuries

KW - Nonoperative management

KW - Outcomes

KW - Solid organ injury

KW - Spleen

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