OPTIMIZATION OF DIAGNOSTICS AND MANAGEMENT OF PATIENTS WITH BLUNT SOLID ORGANS INJURIES IN A LEVEL I TRAUMA CENTER
Original research article
Published August 28, 2023
Keywords
blunt abdominal trauma
solid organs injury
treatment
solid organs injury
treatment
How to Cite
Gavrishchuk Y. V., Manukovsky V. A., Kolchanov E. A., Tulupov A. N., Demko A. E., Kazhanov I. V. OPTIMIZATION OF DIAGNOSTICS AND MANAGEMENT OF PATIENTS WITH BLUNT SOLID ORGANS INJURIES IN A LEVEL I TRAUMA CENTER // Kremlin Medicine Journal. 2023. VOL. № 3. С. 28-33.
Abstract
Interventional radiology has promoted a widespread implementation of minimally invasive treatment into clinical practice; however, currently there is not enough data confirming its effectiveness in patients with blunt abdominal solid organ injuries. Purpose. To analyze outcomes in patients with blunt abdominal solid organs injuries treated with high-tech hybrid diagnostic and surgical technologies. Materials and methods. The researchers analyzed outcomes in 213 hemodynamically stable patients with blunt abdominal solid organ injuries having isolated and combined traumas in a level I trauma center from January 2014 till September 2022. Upon admission, ultrasound examination by FAST protocol was made to identify signs of parenchymal organ injuries. Injury severity was rated with scales for objective assessment: AIS, ISS, Yu.N.Tsybin's scale, scale of military field surgery (VPH-P, VPH-SP). Severity of organ injury was rated using AAST scale. The main group included 118 patients who, in addition to ultrasound examination , had computed tomography (CT) with contrasting agent; and in case of vascular injury, angiography and embolization of injured vessels were added. The control group consisted of 95 patients who were diagnosed and treated with the traditional approach: ultrasound, laparocentesis and laparotomy. The groups were comparable in terms of injury severity and patient's condition. Outcomes of treatment were assessed with the number of open surgeries, rate of complications, length of hospital stay and mortality rate. Results. In the main group, there were less number of laparoscopies and laparotomies due to non-operative and endovascular methods. For example, splenectomy was performed in 18 (30%) patients from the main group and in 44 (84.6%) patients from the control group (p < 0.001). Successful non-surgical treatment was registered in 48.3% of patients from the main group versus 12.6% from the control group (p < 0.001). In spleen injury, non-operative management (NOM) was effective only in the main group (55%). In liver injury, NOM was prescribed to 44.7% of patients from the main group, while only to 9.7% from the control group (p < 0.001). Endovascular treatment in spleen injury was made to 9 (15%) patients; in liver injury – 1 (2.1%) patient; in kidney injury – 1 (3.0%) patient. Much less number of local complications was registered in the main group compared to the control group (p = 0.003). There were no statistically significant differences in the frequency of visceral and generalized complications, duration of hospitalization and mortality. The overall mortality rate was 10.3%; its basic causes were: heart attacks, pulmonary embolism, severe sepsis. Conclusion. Contrast-enhanced CT and X-ray surgical techniques in managing hemodynamically stable patients with parenchymal organs injuries were effective; they promoted a significant reduction of laparoscopies, laparotomies and local complications, if to compare to traditional protocols of treatment.References
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2. Afifi I. et al. Blunt liver trauma: a descriptive analysis from a level I trauma center // BMC Surg. – 2018. – V. 18. – №. 1. – P. 1–9. doi: 10.1186/s12893-018-0369-4.
3. Costa G. et al. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry // Ann Ital Chir . – 2010. – V. 81. – №. 2. – P. 95–102.
4. Smith J. et al. Abdominal trauma: a disease in evolution // ANZ J Surg . – 2005. – V. 75. – №. 9. – P. 790–794. doi: 10.1111/j.1445-2197.2005.03524.x.
5. Еrmolov A.S. et al. Abdominal trauma: a guide for doctors. Moscow: Vidar M publishing office, 2010. In Russian.
6. Asensio J.A. et al. Abdominal vascular injuries. The trauma surgeon's challenge // Ann chir gynaecol. . – 2000. – V. 89. – №. 1. – P. 71–78.
7. Mehta N. et al. An experience with blunt abdominal trauma: evaluation, management and outcome // Clinics and practice. – 2014. – V. 4. – №. 2. – P. 599. DOI: 10.4081/cp.2014.599.
8. Swaid F. et al. Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: an analysis of a National Trauma Registry database // Injury. – 2014. – V. 45. – №. 9. – P. 1409–1412. doi: 10.1016/j.injury.2014.02.027.
9. Wessells H. et al. Renal injury and operative management in the United States: results of a population-based study // J Trauma. – 2003. – V. 54. – №. 3. – P. 423–430. doi: 10.1097/01.ta.0000051932.28456.f4.
10. Meng M.V. et al. Renal trauma: indications and techniques for surgical exploration // World J Urol. – 1999. – V. 17. – P. 71–77. doi: 10.1007/s003450050109.
11. Morey A.F. et al. Urotrauma: AUA guideline // J Urol. – 2014. – V. 192. – №. 2. – P. 327–335. doi: 10.1016/j.juro.2014.05.004.
12. Gavrishuk Y.V. et al. Possibilities of non-operative and minimally invasive organ-preserving spleen injuries management in blunt abdominal injuries in adults // Grekov’s Bulletin of Surgery. – 2021. – V. 180. – №. 4. – P. 18–27. In Russian. doi: 10.24884/0042-4625-2021-180-4-18-27.
13. Gavrishchuk Ya.V. et al. Diagnosis and treatment of kidney damage following stab and blunt abdominal injuries // Surgery. N.I. Pirogov Journal. – 2022. – №. 9. – С. 56–64. In Russian. doi: 10.17116/hirurgia202209156.
14. Heuer M. et al. Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm // Langenbeck's Arch . – 2011. – V. 396. – P. 1067–1076. doi: 10.1007/s00423-011-0836-1.
15. Antonacci N. et al. Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome? // J Hepatobiliary Pancreat Sci. – 2011. – V. 18. – №. 2. – P. 195–201. doi: 10.1007/s00534-010-0329-6.
16. Bavishi D. et al. Management of pancreatic trauma in urban India: a multicenter study // Ann Med Surg. – 2022. – V. 78. – P. 103564. doi: 10.1016/j.amsu.2022.103564
17. Tulupov A.N. et al. Closed Abdominal Injuries. Moscow: GEOTAR-Media, 2021. In Russian.
18. Sargent J.C. Renal injuries // J Urol . – 1950. – V. 63. – №. 1. – P. 1–8. doi: 10.1016/s0022-5347(17)68727-5.
19. Hinton J.W. Injuries to the abdominal viscera: their relative frequency and their management // Ann Surg. – 1929. – V. 90. – №. 3. – P. 351. DOI: 10.1097/00000658-192909000-00003.
20. Mishalany H. Repair of the ruptured spleen // J Pediatr Surg. – 1974. – V. 9. – №. 2. – P. 175–178. doi: 10.1016/s0022-3468(74)80117-x.
21. Howman-Giles R. et al. Splenic trauma – nonoperative management and long-term follow-up by scintiscan // J Pediatr Surg. – 1978. – V. 13. – №. 2. – P. 121–126. doi: 10.1016/s0022-3468(78)80002-5.
22. Longo W.E. et al. Nonoperative management of adult blunt splenic trauma. Criteria for successful outcome // Ann Surg . – 1989. – V. 210. – №. 5. – P. 626. doi: 10.1097/00000658-198911000-00010.
23. Toombs B.D. et al. Computed tomography in blunt trauma //Radiol Clin North Am. – 1981. – V. 19. – №. 1. – P. 17–35.
24. Oldham K.T. et al. Blunt liver injury in childhood: evolution of therapy and current perspective // Surgery. – 1986. – V. 100. – №. 3. – P. 542–549.
25. Hoff W.S. et al. Practice management guidelines for the evaluation of blunt abdominal trauma: the east practice management guidelines work group // J Trauma. – 2002. – V. 53. – №. 3. – P. 602–615. doi: 10.1097/00005373-200209000-00038.
26. Gillman L.M. et al. Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma // Scand J Trauma Resusc Emerg Med . – 2009. – V. 17. – №. 1. – P. 1–14. doi: 10.1186/1757-7241-17-34.
27. Baque P. et al. A new method to approach exact hemoperitoneum volume in a splenic trauma model using ultrasonography // Surg Radiol Anat . – 2005. – V. 27. – P. 249–253. doi: 10.1007/s00276-004-0307-2.