A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury

Darren Malinoski, Madhukar S. Patel, Didem Oncel Yakar, Donald Green, Faisal Qureshi, Kenji Inaba, Carlos V R Brown, Ali Salim

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Hollow viscus injuries (HVI) are uncommon after blunt trauma, and accomplishing a timely diagnosis can be difficult. Time to operative intervention has been implicated as a risk factor for mortality, but reports are conflicting. Methods: All blunt trauma admissions to an academic level 1 trauma center from January 1992 to September 2005 were retrospectively reviewed. Patients with a diagnosis of blunt HVI were included. Patients who died within 24 hours were excluded. Data regarding patient demographics, injuries, time from admission until laparotomy, length of stay, and mortality were recorded, and a multivariate analysis to determine independent risk factors for mortality was carried out. A p <0.05 was considered significant. Results: Of 35,033 blunt trauma admissions, there were 195 (0.6%) HVI patients with the following characteristics (data expressed as mean ± 1 SD): mean age of 35 years ± 16 years, Injury Severity Score of 17 ± 11, time from admission to laparotomy of 5.9 hours ± 5.8 hours, operative blood loss of 1500 mL ± 1800 mL, and length of stay of 19 days ± 23 days. Twelve percent presented with a systolic pressure 5 hours were because of abdominal-related sepsis. Conclusion: HVI occurred in less than 1% of all blunt trauma admissions. Delays in operative intervention are associated with an increased mortality. A high index of suspicion is needed to make a timely diagnosis and minimize risk.

Original languageEnglish (US)
Pages (from-to)84-87
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number1
DOIs
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Viscera
Wounds and Injuries
Mortality
Laparotomy
Length of Stay
Injury Severity Score
Trauma Centers
Operative Time
Sepsis
Multivariate Analysis
Demography
Blood Pressure

Keywords

  • Blunt hollow viscus injury
  • Diagnostic delay
  • Laparotomy
  • Mortality

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. / Malinoski, Darren; Patel, Madhukar S.; Yakar, Didem Oncel; Green, Donald; Qureshi, Faisal; Inaba, Kenji; Brown, Carlos V R; Salim, Ali.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 1, 07.2010, p. 84-87.

Research output: Contribution to journalArticle

Malinoski, Darren ; Patel, Madhukar S. ; Yakar, Didem Oncel ; Green, Donald ; Qureshi, Faisal ; Inaba, Kenji ; Brown, Carlos V R ; Salim, Ali. / A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 1. pp. 84-87.
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abstract = "Background: Hollow viscus injuries (HVI) are uncommon after blunt trauma, and accomplishing a timely diagnosis can be difficult. Time to operative intervention has been implicated as a risk factor for mortality, but reports are conflicting. Methods: All blunt trauma admissions to an academic level 1 trauma center from January 1992 to September 2005 were retrospectively reviewed. Patients with a diagnosis of blunt HVI were included. Patients who died within 24 hours were excluded. Data regarding patient demographics, injuries, time from admission until laparotomy, length of stay, and mortality were recorded, and a multivariate analysis to determine independent risk factors for mortality was carried out. A p <0.05 was considered significant. Results: Of 35,033 blunt trauma admissions, there were 195 (0.6{\%}) HVI patients with the following characteristics (data expressed as mean ± 1 SD): mean age of 35 years ± 16 years, Injury Severity Score of 17 ± 11, time from admission to laparotomy of 5.9 hours ± 5.8 hours, operative blood loss of 1500 mL ± 1800 mL, and length of stay of 19 days ± 23 days. Twelve percent presented with a systolic pressure 5 hours were because of abdominal-related sepsis. Conclusion: HVI occurred in less than 1{\%} of all blunt trauma admissions. Delays in operative intervention are associated with an increased mortality. A high index of suspicion is needed to make a timely diagnosis and minimize risk.",
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