TY - JOUR
T1 - The distinct and secondary harmful effect of pelvic and extremity injury on the outcome of laparotomy for trauma
AU - Prince, Rebecca A.
AU - Hoffman, Christopher J.
AU - Scanlan, Richard M.
AU - Mayberry, John C.
PY - 2005/3
Y1 - 2005/3
N2 - Hypothesis. Extra-abdominal injury negatively affects the outcome of abdominal injury following trauma laparotomy. Design. Retrospective review of 920 consecutive patients receiving laparotomy for trauma who survived more than 24 h between January 1989 and May 1998 at a Level 1 trauma center. Major abdominal complications (MAC) were defined as: abdominal compartment syndrome (ACS), abscess/peritonitis, enterocutaneous fistula, necrotizing fasciitis, and necrotizing pancreatitis. Methods. Univariant and multivariant logistic regression were used to identify predictors of MAC. Results. Sixty-nine patients (7.5%) developed one or more MAC. Patients who developed MAC had higher injury severity scores (ISS), abdominal trauma indices (ATI), and blood transfusions in the first 24 h (PRCs) than patients who did not develop MAC. Patients with MAC were more likely to have suffered a thoracic or pelvic injury with an abbreviated injury scale (AIS) <3 and were more likely to have received an extremity injury (AIS <3) operation than patients without MAC. Independent predictors of MAC in multivariant analysis included colon injury (AIS <3) [odds ratio (OR) = 3.1, 95% confidence interval (CI) 1.5- 6.3)], pelvic injury (AIS <3) or operation for extremity injury (AIS <3) [OR 2.9, 95% CI 1.5-5.3], and ATI (OR = 1.03 for each 10 unit increase in ATI, 95% CI 1.02-1.05). PRCs did not independently predict MAC. Conclusion. The outcome of laparotomy for trauma (both blunt and penetrating) is negatively affected by a severe pelvic injury or a severe extremity injury operation independent of initial hemorrhage and abdominal injury severity.
AB - Hypothesis. Extra-abdominal injury negatively affects the outcome of abdominal injury following trauma laparotomy. Design. Retrospective review of 920 consecutive patients receiving laparotomy for trauma who survived more than 24 h between January 1989 and May 1998 at a Level 1 trauma center. Major abdominal complications (MAC) were defined as: abdominal compartment syndrome (ACS), abscess/peritonitis, enterocutaneous fistula, necrotizing fasciitis, and necrotizing pancreatitis. Methods. Univariant and multivariant logistic regression were used to identify predictors of MAC. Results. Sixty-nine patients (7.5%) developed one or more MAC. Patients who developed MAC had higher injury severity scores (ISS), abdominal trauma indices (ATI), and blood transfusions in the first 24 h (PRCs) than patients who did not develop MAC. Patients with MAC were more likely to have suffered a thoracic or pelvic injury with an abbreviated injury scale (AIS) <3 and were more likely to have received an extremity injury (AIS <3) operation than patients without MAC. Independent predictors of MAC in multivariant analysis included colon injury (AIS <3) [odds ratio (OR) = 3.1, 95% confidence interval (CI) 1.5- 6.3)], pelvic injury (AIS <3) or operation for extremity injury (AIS <3) [OR 2.9, 95% CI 1.5-5.3], and ATI (OR = 1.03 for each 10 unit increase in ATI, 95% CI 1.02-1.05). PRCs did not independently predict MAC. Conclusion. The outcome of laparotomy for trauma (both blunt and penetrating) is negatively affected by a severe pelvic injury or a severe extremity injury operation independent of initial hemorrhage and abdominal injury severity.
KW - Abdomen
KW - Complications
KW - Extra-abdominal injury
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=13944276823&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=13944276823&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2004.09.016
DO - 10.1016/j.jss.2004.09.016
M3 - Article
C2 - 15734472
AN - SCOPUS:13944276823
SN - 0022-4804
VL - 124
SP - 3
EP - 8
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -