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Mirzamohamadi S, HajiAbbasi MN, Baigi V, Salamati P, Rahimi-Movaghar V, Zafarghandi M, Isfahani MN, Fakharian E, Saeed-Banadaky SH, Hemmat M, Sadrabad AZ, Daliri S, Pourmasjedi S, Piri SM, Naghdi K, Yazdi SAM. Patterns and outcomes of patients with abdominal injury: a multicenter study from Iran. BMC Emerg Med 2024; 24:91. [PMID: 38816710 PMCID: PMC11141001 DOI: 10.1186/s12873-024-01002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI). METHODS This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals. RESULTS Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p < 0.001). Negative laparotomies were 21 (28%) in penetrating trauma and only 11 (7.7%) in blunt group (p < 0.001). In the multiple logistic regression model after adjusting, ISS ≥ 16 increased the chance of ICU admission 3.13 times relative to the ISS 1-8 [OR: 3.13, 95% CI (1.56 to 6.28), P = 0.001]. Another predictor was NOM, which increased ICU chance 1.75 times more than OM [OR: 1.75, 95% CI (1.17 to 2.61), p = 0.006]. Additionally, GCS 3-8 had 5.43 times more ICU admission odds than the GCS 13-15 [OR:5.43, 95%CI (1.81 to 16.25), P = 0.002] respectively. CONCLUSION This study found that the liver and spleen are mostly damaged in blunt injuries. Also, in most cases of penetrating injuries, the colon and small intestine had the highest frequency of injuries compared to other organs. Blunt abdominal injuries caused more blood transfusions and ICU admissions. Higher ISS, lower GCS, and NOM were predictors of ICU admission in abdominal injury victims.
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Affiliation(s)
- Sara Mirzamohamadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | | | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Mohammadreza Zafarghandi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Mehdi Nasr Isfahani
- Trauma Data Registration Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Houssein Saeed-Banadaky
- Trauma Research Center, School of Medicine, Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Akram Zolfaghari Sadrabad
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sobhan Pourmasjedi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran
| | - Seyed Amir Miratashi Yazdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, 1136746911, Iran.
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Liu T, Fang X, Bai Z, Liu L, Lu H, Qi X. Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis. Int J Surg 2024; 110:1183-1195. [PMID: 38051918 PMCID: PMC10871643 DOI: 10.1097/js9.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIMS Abdominal gunshot wounds (GSWs), a clinically devastating injury, can result in a variety of severe and lethal complications. Traditionally, exploratory laparotomy is the first-line approach for the management of abdominal GSWs, but it is associated with a considerable amount of unnecessary surgeries. At present, selective non-operative management (SNOM) of abdominal GSWs is becoming an effective and well-recognized approach, but it remains widely disputed since many surgeons are skeptical about the validity of SNOM in clinical practice. This meta-analysis aims to estimate the outcomes of SNOM and immediate laparotomy in patients with GSWs by collecting the currently available evidence. METHODS The PubMed , EMBASE , and Cochrane Library databases were searched. A random-effects model was employed. A pooled proportion with 95% confidence intervals (CIs) was calculated. Heterogeneity was evaluated using Cochran's Q test and I2 statistics. RESULTS Overall, 53 studies involving 60 291 participants were included. The pooled proportions of SNOM and SNOM failure were 27.0% (95% CI=24.0-30.0%) and 10.0% (95% CI=7.0-13.0%), respectively. The pooled mortality after SNOM and SNOM failure were 0.0% (95% CI=0.0-1.0%) and 0.0% (95% CI=0.0-0.0%), respectively. The pooled proportions of immediate laparotomy and unnecessary immediate laparotomy were 73.0% (95% CI=70.0-76.0%) and 10.0% (95% CI=8.0-13.0%), respectively. The pooled mortality after immediate laparotomy and unnecessary immediate laparotomy was 10.0% (95% CI=8.0-13.0%) and 0.0% (95% CI=0.0-1.0%), respectively. Heterogeneity was statistically significant in nearly all meta-analyses. CONCLUSION Immediate laparotomy is still the mainstay approach for the management of abdominal GSWs. Approximately one-third of patients with abdominal GSWs undergo SNOM. SNOM failure is not frequent, and its related mortality is also rare.
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Affiliation(s)
- Tingwei Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Graduate School, Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Xiaohui Fang
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Zhaohui Bai
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
- Shenyang Pharmaceutical University, Shenyang
| | - Lu Liu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Hui Lu
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
| | - Xingshun Qi
- Military Medical Research Group, General Hospital of Northern Theater Command, Shenyang, Liaoning Province
- Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command
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Dayem AYA, Aiad GAN, Mikhail HMS, Elshwadfy M, Al Aziz AA. Comparative Study between Operative and Conservative Management of Penetrating Anterior Abdominal Stab Injuries. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Presently, non-operative management of penetrating abdominal stab injuries has been standardized in several trauma centers. This strategy has appromising outcome conserving decreasing morbidity.
Aim of the work: This study aimed to assess the safety and feasibility of SNOM of patients having penetrating abdominal stab injuries not indicating emergent laparotomy and to identify a protocol for selection of patient candidates for non-operative management in a tertiary care hospital in Egypt.
Patients & Methods: This is a prospective study that involved patients who presented to the casualty department of Kasr Elainy teaching Hospital, in the period from August 2018 to August 2020, for management of a penetrating abdominal Stab injuries. Fully conscious, haemodynimacally stable patients were included. Eligible patients were allocated to either SNOM group or immediate operative management (IOM) group.
Results: SNOM group included64 patients and IOM group included 40 patients. The age of the patients ranged from 16 to 49 years with a mean of 33±6.8 years, and the majority were males (99%). SNOM failed in 4/69 patients (5.7%) who required delayed laparotomy for peritonitis (2 cases) and HB drop and haemodynamic instability (2 cases). In IOM group, only 3 cases had therapeutic laparotomies (7.3%). The remaining cases had unnecessary laparotomies (92.7%). Statistically significant higher LOS was seen in SNOM group (p<0.05). However, less unnecessary laparotomies and lower incidences of complications were noted (p<0.01).
Conclusion: vital signs together with abdominal examination are the most important clinical criteria in decision making in penetrating abdominal stab injury patients When surgery is not absolutely indicated, SNOM is a safe and feasible approach in management of penetrating abdominal stab injury by following proper management algorithm and selection criteria.
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