Multiplicity of Solid Organ Injury: Influence on Management and Outcomes after Blunt Abdominal Trauma

Department of Surgery, Virginia Commonwealth University, Ричмонд, Virginia, United States
The Journal of trauma (Impact Factor: 2.96). 05/2003; 54(5):925-9. DOI: 10.1097/01.TA.0000066182.67385.86
Source: PubMed


The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes.
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.
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.
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.

6 Reads
  • Source
    • ". The additional benefits of this classification were a correlation between the degree of injury and outcome [10] [11], and the ease of quantification of associated injuries using similarly devised Organ Injury Scales. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The liver is the most frequently injured intra-abdominal organ and associated injury to other organs increases the risk of complications and death. This has highlighted the critical need for an accurate classification system as a basis for the clinical decision-making process. Several classification systems have been proposed in an attempt to incorporate the aetiology, anatomy and extent of injury and correlate it with subsequent clinical management and outcome. The widely accepted Organ Injury Scale is based on anatomical criteria that quantify the disruption of the liver parenchyma and defines six groups which may influence management strategies and relate to outcome. The less common pancreatic injury remains a major source of morbidity and mortality due to the likelihood of associated solid or hollow-organ injuries. The implication of a delay in diagnosis and management emphasizes the need for an accurate classification system. The Organ Injury Scale is widely used for pancreas trauma and recognizes the importance of progressive parenchymal injury and in particular ductal injury. Advances in imaging techniques have led to the development of newer radiological classification systems; however, validation of their accuracy remains to be proven. An accurate classification of liver and pancreatic trauma is fundamental for the development of treatment protocols in which clinical decisions are based on the severity of injury.
    HPB 02/2006; 8(1):4-9. DOI:10.1080/13651820500465881 · 2.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This overview addresses the indications for laparotomy following trauma. The authors will suggest algorithms and tenants of care, but there is not a cookie-cutter approach that incorporates all trauma patients or their injuries. Laparotomy for trauma is an individualized decision based collectively upon clinical evaluation and diagnostic adjuncts. Multiple tools exist within the surgeon’s armamentarium, including focused abdominal sonography for trauma (FAST) exam, diagnostic peritoneal aspirate (DPA)/diagnostic peritoneal lavage (DPL), imaging, and laparoscopy, to facilitate diagnosis and management of the trauma patient. Care for each injured patient requires experienced clinical evaluation, time-honed judgment, and individualized treatment. Junior trainees are often reminded of the value of experience in the trauma bay when a misstep in management occurs. Appropriate and timely intervention will limit the number of nontherapeutic laparotomies and their attendant morbidity.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Holographic tweezers are based on computer-generated holograms displayed on a spatial light modulator (e.g. an LCD, DMD etc.). In biological imaging there are many sources of aberrations a spatial light modulator offers the possibility to control these aberrations. In our setup the spatial light modulator is used to modulate the trapping laser as well as to influence the imaging path. The aberrated particle image can be improved by writing a compensation function into the light modulator. The appropriate function is found by iteratively changing a linear combination of Zernike polynomials
Show more