Pre- and post-implementation protocol for non-operative management of grade III-V splenic injuries: An observational study

Background

Grade (III-V) blunt splenic injuries (BSI) in hemodynamically stable patients represent clinical challenges for successful non-operative management (NOM). In 2014, Our institution proposed a treatment protocol requiring splenic angiography and embolization for stable, intermediate, and high-grade BSI. It also included a follow-up CT scan for grade III BSI. We sought to assess the success rate of NOM in treating intermediate and high-grade BSI, following a standardized treatment protocol at a level 1 trauma center.

Methods

An observational retrospective study was conducted. Data of patients with BSI from June 2011 to September 2019 were reviewed using the Qatar National Trauma Registry. Patients' demographics, CT scan and angiographic findings, grade of splenic injuries, and outcomes were analyzed. The pre- and post-implementation of treatment protocol periods were compared.

Results

During the study period, a total of 552 hemodynamically stable patients with BSI were admitted, of which 240 had BSI with grade III to V. Eighty-one patients (33.8%) were admitted in the pre-protocol implementation period and 159 (66.2%) in the post-protocol implementation period. The NOM rate increased from 50.6% in the pre-protocol group to 65.6% in the post-protocol group (p = 0.02). In addition, failure of the conservative treatment did not significantly differ in the two periods, while the requirement for blood transfusion dropped from 64.2% to 45.9% (p = 0.007). The frequency of CT scan follow-up (55.3% vs. 16.3%, p = 0.001) and splenic arterial embolization (32.7% vs. 2.5%, p = 0.001) in NOM patients increased significantly in the post-protocol group compared to the pre-protocol group. Overall mortality was similar between the two periods. However, hospital and ICU length of stay and ventilatory days were higher in the post-protocol group.

Conclusions

NOM is an effective and safe treatment option for grade III-V BSI patients. Using standardized treatment guidelines for intermediate-to high-grade splenic injuries could increase the success rate for NOM and limit unnecessary laparotomy. Moreover, angioembolization is a crucial adjunct to NOM that could improve the success rate.

Trauma Quality Improvement Program: A Retrospective Analysis from A Middle Eastern National Trauma Center

BACKGROUND

The Trauma Quality Improvement Program (American College of Surgery (ACS-TQIP)) uses the existing infrastructure of the Committee on Trauma programs and provides feedback to participating hospitals on risk-adjusted outcomes. This study aimed to analyze and compare the performance of the Level I Hamad Trauma Centre (HTC) with other TQIP participating centers by comparing TQIP aggregate database reports. The primary goal was to pinpoint the variations in adult trauma outcomes and quality measures, identify areas that need improvement, and leverage existing resources to facilitate quality improvement.

METHODS

A retrospective analysis was performed for the TQIP data from April 2019-March 2020 to April 2020-March 2021. We used the TQIP methodology, inclusion and exclusion criteria, and outcomes.

RESULTS

There were 915 patients from Fall 2020 and 884 patients from Fall 2021 that qualified for the TQIP database. The HTC patients' demographics differed from the TQIP's aggregate data; they were younger, more predominantly male, and had significantly different mechanisms of injury (MOI) with more traffic-related blunt trauma. Penetrating injuries were more severe in the other centers. During the TQIP Fall 2020 report, the HTC was a low outlier (good performer) in one cohort (all patients) and an average performer in the remaining cohorts. However, during Fall 2021, the HTC showed an improvement and was a low outlier in two cohorts (all patients and severe TBI patients). Overall, the HTC remained an average performer during the report cycles.

CONCLUSIONS

There was an improvement over time in the risk-adjusted mortality, which reflects the continuous and demanding effort put together by the trauma team. The ACS-TQIP for the external benchmarking of quality improvement could be a contributor to better monitored patient care. Evaluating the TQIP data with emphases on appropriate methodologies, quality measurements, corrective measures, and accurate reporting is warranted.

Acute Changes in Body Muscle Mass and Fat Depletion in Hospitalized Young Trauma Patients: A Descriptive Retrospective Study

Background: Loss of muscle mass, and its strength, is associated with adverse outcomes in many medical and surgical conditions. Trauma patients may get malnourished during their hospital course due to many interrelated contributing factors. However, there is insufficient knowledge on the acute muscle and fat changes in young trauma patients in the early days post-admission. Objective: to explore the diagnosis, feeding status, and outcome of muscle mass loss among young abdominal polytrauma patients. Methods: It was a retrospective study including hospitalized abdominal trauma patients who underwent an abdominal computerized tomographic (CT) examination initially and a follow-up one week later. CT scan-based automatic and manual analysis of the muscles and fat of the abdominal region was calculated and compared. Also, we evaluated the feeding and nutritional values to explore the adequacy of the provided calories and proteins and the potential influence of enteral feeding on the CT-based parameters for muscle loss and fat depletion. Results: There were 138 eligible subjects with a mean age of 32.8 ± 13.5 years; of them, 92% were males. Operative interventions were performed on two-thirds of the patients, including abdominal surgery (43%), orthopedic surgeries (34%), and neurosurgical procedures (8.1%). On admission, 56% received oral feeding, and this rate slightly increased to 58.4% after the first week. Enteral feed was prescribed for the remaining, except for two patients. The percentage of change in the total psoas muscle area was significantly reduced after one week of admission in patients on enteral feed as compared to those in the oral feeding group (p = 0.001). There were no statistically significant differences in the percentages of changes in the CT scan findings except for the total psoas muscle area (p = 0.001) and para-spinal muscle area (p = 0.02), which reduced significantly in the those who underwent laparotomy as compared to those who did not need laparotomy. Trauma patients who underwent emergency abdominal surgery lost muscle and fat over time. Conclusions: Loss of muscle mass and body fat is not uncommon among young trauma patients. Patients who underwent laparotomy are more likely to be affected. Further larger studies are needed to assess the specific features in the younger trauma population and how far this can be influenced by the nutrition status and its impact on the clinical outcomes. It could be early or impending stages of sarcopenia linked to trauma patients, or just acute changes in the muscle and fat, that need further investigation and follow-up after hospital discharge.

Diagnosis, management and outcome of Spinal Cord Injury without Radiographic Abnormalities (SCIWORA) in adult patients with trauma: a case series

Background: Spinal cord injury without radiographic abnormality (SCIWORA) in adults causes diagnostic and prognostic dilemma as radiography and/or computed tomography does not clearly detect bone lesions during the initial assessment. Herein, we report our experience on 11 spinal cord injury cases without radiographic abnormality, regarding the clinicoradiological features, management, and outcomes.

Methods: We conducted a case series of adult patients with SCIWORA who were admitted at the level 1 trauma center at Hamad General Hospital from January 2008 to July 2018. All patients underwent initial head and spine X-ray imaging, computed tomography, magnetic resonance imaging, and 12 months of clinical follow-up.

Results: Eleven patients (mean age, 46.5 ± 14.4 years) met the criteria of SCIWORA. The neurologic status on admission and 12 months after hospital discharge were classified according to the American Spinal Injury Association (ASIA) impairment scale (AIS). On admission, 6 (54.5%) patients had ASIA grade C: 2 (18.2%) each had AIS grade D and B and 1 (9.1%) had AIS grade A. Five cases were treated conservatively with rehabilitation and physiotherapy, and five were treated surgically by anterior cervical discectomy with fusion. One patient who declined surgery was managed with a sternal occipital mandibular immobilizer brace and underwent rehabilitation.

Conclusion: SCIWORA requires higher clinical suspicion and thorough neurological and radiologic assessment to prevent secondary spinal cord injuries and complications.

Prediction of in-hospital mortality in patients on mechanical ventilation post traumatic brain injury: machine learning approach

Background

The study aimed to introduce a machine learning model that predicts in-hospital mortality in patients on mechanical ventilation (MV) following moderate to severe traumatic brain injury (TBI).

Methods

A retrospective analysis was conducted for all adult patients who sustained TBI and were hospitalized at the trauma center from January 2014 to February 2019 with an abbreviated injury severity score for head region (HAIS) ≥ 3. We used the demographic characteristics, injuries and CT findings as predictors. Logistic regression (LR) and Artificial neural networks (ANN) were used to predict the in-hospital mortality. Accuracy, area under the receiver operating characteristics curve (AUROC), precision, negative predictive value (NPV), sensitivity, specificity and F-score were used to compare the models` performance.

Results

Across the study duration; 785 patients met the inclusion criteria (581 survived and 204 deceased). The two models (LR and ANN) achieved good performance with an accuracy over 80% and AUROC over 87%. However, when taking the other performance measures into account, LR achieved higher overall performance than the ANN with an accuracy and AUROC of 87% and 90.5%, respectively compared to 80.9% and 87.5%, respectively. Venous thromboembolism prophylaxis, severity of TBI as measured by abbreviated injury score, TBI diagnosis, the need for blood transfusion, heart rate upon admission to the emergency room and patient age were found to be the significant predictors of in-hospital mortality for TBI patients on MV.

Conclusions

Machine learning based LR achieved good predictive performance for the prognosis in mechanically ventilated TBI patients. This study presents an opportunity to integrate machine learning methods in the trauma registry to provide instant clinical decision-making support.

Psychological trauma in different mechanisms of traumatic injury: A hospital-based cross-sectional study

Background

Psychological distress following traumatic injury can influence the patient health, well-being and quality of life; however, this impact may partly vary according to the type and severity of injury. We aimed to study the predominant distress causing cluster and individual symptoms of Post-Traumatic Stress Disorders (PTSD) at the clinical and subthreshold level in patients with traumatic injuries, based on the mechanism of injury (MOI).

Methods

A hospital based cross-sectional study was conducted at a Level 1 Trauma Center utilizing PTSD Checklist to diagnose PTSD after one month of the traumatic event. All patients suffering from psychological distresses were assessed by a clinical psychologist in the trauma section. PTSD diagnostic criteria from DSM-5 were used to classify the patients. The inclusion criteria comprised of adult trauma patients who were directly involved in traumatic injuries and admitted under the Trauma Surgery services for a minimum of one day; have ability to provide written informed consent and can be assessed with the PCL-5 checklist after 4 weeks post-injury.

Results

Two hundred patients completed PCL-5 checklist, of them 26 (13.0%) were positive for PTSD and 174 (87%) had subthreshold scores. The mean age of participants was 34.4±11.8 years and males constituted 90.5%. Road traffic injury (RTI) was most the frequent injury mechanism (59%). PTSD positive patients with RTI, fall of heavy objects, pedestrian injury and assaults had highest average scores on clusters of negative alterations in mood and cognitions (16.9, 18.0, 18.5, 17.0 respectively), followed by hyperarousal. Symptom of always being on the guard and having repeated unwanted or disturbing memories of the incident, was reported by nearly 100% PTSD positive patients. Patients with subthreshold scores also reported distressing symptoms on all four clusters of PTSD.

Conclusions

Patients with different MOI showed a broad range of psychological problems with respect to symptom clusters. Negative alteration in mood and cognition followed by hyperarousal caused higher level of distress in patients post traumatic injuries. Subthreshold symptoms of PTSD are more common and deserve more attention.

Violence -related injuries in a rapidly developing Middle Eastern country: a retrospective study from a level 1 trauma center

Background

Violence is a global public health concern leading to injuries, long-term physical, sexual or mental health problems and even mortality. The burden of violence-related injuries on hospital systems remains understudied in the Arabian Gulf region. The present study aimed to describe the epidemiology of hospitalized violence-related injuries in a rapidly developing Middle Eastern country.

Methods

A retrospective analysis from a level 1 trauma center, in the state of Qatar, was conducted. Data were retrieved from the Qatar national trauma registry for all patients who were admitted with violence-related injuries between June 2010 and June 2017. Analyzed data were used to compare hospitalized interpersonal and self-inflicted violence groups.

Results

The hospitalization rate of violence-related injuries was 4.6 per 100,000 population per year; it was significantly higher in males (5.5/100,000 males/year vs. 1.8/100,000 females/year) and younger persons, particularly in the 25–34 years old population (41%). South Asians constituted 55% of the affected study population. Interpersonal violence (76.7%) was the most common mechanism of injury. Significant differences between interpersonal and self-inflicted violence groups were evident, especially for the type of trauma (i.e. blunt or penetrating), injured body regions, alcohol use, injury severity, need for intubation and psychiatric referral (p < 0.05). Overall, in-hospital mortality was 6.4%; with a significantly higher rate in females (16% vs.5%, p = 0.001). Outcomes, including length of hospital stay and mortality, were comparable between the two study groups. Multivariate analysis showed that male gender and alcohol use were predictors for interpersonal violence whereas high Injury Severity Score (ISS) and low Glasgow Coma Scale (GCS) were predictors of hospital mortality.

Conclusions

The rate of hospitalization for violence-related injuries in Qatar is low; however, its burden on the trauma system is of concern. Although it comprised only 9.6% of the study population, females are more likely to get hospitalized following self-inflicted injuries when compared to interpersonal violence. The disproportionate burden of violence among South Asian and young populations warrants an evidence-based public health approach to appropriately address the risk factors and set prevention programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09754-7.

Traumatic injuries associated with suicide attempts: A retrospective study from single national level 1 trauma center

Background:

Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center.

Methods:

We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018.

Results:

During this 10–year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders.

Conclusions:

The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.

Prediction of in-hospital mortality in patients with post traumatic brain injury using National Trauma Registry and Machine Learning Approach

BACKGROUND

The use of machine learning techniques to predict diseases outcomes has grown significantly in the last decade. Several studies prove that the machine learning predictive techniques outperform the classical multivariate techniques. We aimed to build a machine learning predictive model to predict the in-hospital mortality for patients who sustained Traumatic Brain Injury (TBI).

METHODS

Adult patients with TBI who were hospitalized in the level 1 trauma center in the period from January 2014 to February 2019 were included in this study. Patients' demographics, injury characteristics and CT findings were used as predictors. The predictive performance of Artificial Neural Networks (ANN) and Support Vector Machines (SVM) was evaluated in terms of accuracy, Area Under the Curve (AUC), sensitivity, precision, Negative Predictive Value (NPV), specificity and F-score.

RESULTS

A total of 1620 eligible patients were included in the study (1417 survival and 203 non-survivals). Both models achieved accuracy over 91% and AUC over 93%. SVM achieved the optimal performance with accuracy 95.6% and AUC 96%.

CONCLUSIONS

for prediction of mortality in patients with TBI, SVM outperformed the well-known classical models that utilized the conventional multivariate analytical techniques.

Pediatric road traffic injuries in Qatar: Evidence for a developmental stage approach to road safety

Road traffic injuries are the leading cause of death in Qatar but their epidemiology in children has not been fully described. This paper will describe the epidemiology of pediatric road traffic injuries (pRTIs) in Qatar, in order to understand the relationships among risk factors, mechanisms of injury, use of safety equipment, and according to child developmental stages. The primary sample for this study was drawn from all pRTIs (0-18 years) from January 2010 to December 2012-motor vehicle occupants, passengers and drivers, pedestrians, cyclists, motorcyclists, and all-terrain vehicle (ATV) drivers and passengers-seen at the trauma registry of the Hamad Trauma Center, the national Level I Trauma Referral Center of Qatar. During those two years, the Trauma Center attended to 4864 patients, 443 (9.1%) of whom were pRTIs, 83% were male, and 71% were non-Qatari. Only 1.2% of injured passengers and drivers were restrained. All fatalities were passengers or drivers; the overall mortality rate was 3.4%. The motor vehicle crash (MVC) mortality rate was 6.2%, with the longest mean length of hospital stay 10.5 days and highest Intensive Care Unit (ICU) admission rate 35.7%. Older adolescents (15-18 years) comprised 56.4% of total MVC mortality. One-in-four (25%) pedestrian victims was Qatari. They had the lowest mean Injury Severity Score (9.6); 73% were nine years or younger. ATV victims had a 27% ICU admission rate; 48.4% were 10-14 years old. Older adolescents made up only 17% of the pediatric population of Qatar, yet 40% of pRTI victims and 80% of pRTI deaths. Forty-two percent of injured older adolescents were drivers, with half (21%) of those underage. There are clear and distinct age and mechanism-specific patterns of pRTIs among children in Qatar that must be used to guide road safety policy and program formulation for underage pedestrians and drivers. Proven interventions that increase seatbelt and child restraint use and graduated driver licensing must be considered.

Evolution of The Qatar Trauma System: The Journey from Inception to Verification

Traumatic injuries accounted for substantial burden of morbidity and mortality (M and M) worldwide. Despite better socioeconomic conditions and living standards, the incidence of trauma is rising in the Eastern Mediterranean Region (EMR). Road traffic injuries are the leading cause of the high fatality rate in young economically productive adults in our region. The provision of trauma care at high-volume, accredited trauma center by a team of dedicated full-time professional health-care providers has been shown to improve the quality of care and the outcomes for trauma victims. With persistent hard work and effective leadership, in Qatar, the Trauma Section has evolved into a well-reputed and internationally recognized Center of Excellence in Trauma Care, Hamad Level 1 Trauma Center. In 2014, Qatar Trauma System was accredited with Trauma Distinction Award by the Accreditation Canada International, for high-quality trauma care of severely injured patients; first in the Middle East. The Hamad Trauma Center is committed to the advancement of trauma care in different aspects right from the immediate prehospital care to the subsequent hospital-based care, involving diagnosis, treatment, support, rehabilitation, and community reintegration of the patients and injury prevention. Our trauma system has gradually embedded with a structured and matured research unit with dedicated clinicians and academic researchers. The trauma team embodies the 21^st-century paradigm of translational research and injury prevention by going well beyond the bedside, out into the populations that need it most. The trauma system's future vision relies on the evidence-based health-care service and better outcomes; state-of-the-art infrastructure and multidimensional collaborations with health care and governmental services to minimize the burden of M and M caused by traumatic injury in the State of Qatar and to fulfill the population health enhancement strategy.

Hospital Mortality Based on the Mode of Emergency Medical Services Transportation

OBJECTIVE

We assessed the presentations and outcomes of trauma patients transported by helicopter emergency medical services (HEMS) versus ground emergency medical services (GEMS).

METHODS

A retrospective analysis of trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Data were analyzed and categorized based on the mode of transportation.

RESULTS

A total of 4,596 trauma patients were admitted to the hospital with a mean age of 31 ± 15 years. Injured patients were transported to the trauma center by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and falls (25%). Compared with GEMS, patients transported by HEMS were characterized by having a greater injury severity, more proportion of traumatic brain injury, on-scene intubation, and a 2.5-fold higher mortality. However, the impact of mode of transportation on the hospital mortality among severely injured patients has disappeared after adjusting for potential confounders.

CONCLUSION

Patients transported by HEMS may have different characteristic features and outcomes when compared with GEMS. However, further work is needed to identify the subgroups of trauma patients who clearly benefit from the use of HEMS.

In-Hospital Outcome Based on the Mode of EMS Transportation in a High-Income Rapidly Developing Middle Eastern Country

<p><strong>BACKGROUND:</strong> Helicopter emergency medical services (HEMS) are considered as a standard component of advanced pre-hospital emergency care system. We assessed the clinical presentation and outcomes of trauma patients transported by HEMS versus ground emergency medical services (GEMS).</p><p><strong>METHODS:</strong> A retrospective analysis of prospectively collected trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Patients’ data were categorized and analyzed based on the mode of transportation (MOT).</p><p><strong>RESULTS:</strong> A total of 4596 trauma patients were admitted to the hospital with a mean age of 31±15 years. Injured patients were transported to the trauma centre by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and fall (25%). MVC victims were transported to the hospital by HEMS, whereas, patients with fall and pedestrian injuries (P=0.001 for all) were more likely to be transported by GEMS. Moreover, patients in the HEMS group had a higher frequency of head (p=0.001) and chest (p=0.001) injuries and required prolonged ICU and overall hospital stay (p=0.001). When compared with GEMS, HEMS group were more likely to sustain severe injuries (ISS&gt;15; p=0.001) and needed frequent on-scene intubation (P=0.001). Hospital mortality was grater in HEMS patients (10% vs 4%, p=0.001) in comparison to GEMS. Multivariate analysis, after adjusting for the confounding factors demonstrated that polytrauma and lower scene GCS were the independent predictors of mortality.</p><p><strong>CONCLUSIONS: </strong>Patients transported by HEMS are characterized by greater injury severity, traumatic brain injury and on-scene intubation. Moreover, the mortality is 2.5 fold greater in patients transported by GEMS, however, the impact of MOT on mortality disappear after adjusting for potential confounders. Institutional guidelines that focus on clinical triage criteria, key environmental factors and reducing transport time may be informed by this study. Further investigations are needed to better quantifyestimate the pre-hospital time intervals and to identify the sub-groups of trauma patients who will clearly benefit from the use of HEMS.</p>

Dilemma of Blunt Bowel Injury: What are the Factors Affecting Early Diagnosis and Outcomes

Blunt bowel and mesenteric injury (BBMI) is frequently a difficult diagnosis at initial presentation. We aimed to study the predictors for early diagnosis and outcomes in patients with BBMI. Data were collected retrospectively from the database registry between January 2008 and December 2011 in the only Level I trauma unit in Qatar. Patients with BBMI were divided into Group A (surgically treated within 8 hours) and Group B (treated after 8 hours). Data were analyzed and χ2, Student's t test, and multivariate regression analysis were performed appropriately. Among 984 patients admitted with blunt abdominal trauma (BAT), 11 per cent had BBMI with mean age of 35 ± 9.5 years. Polytrauma and isolated bowel injury were identified in 53 and 42 per cent, respectively. Mean Injury Severity Score (ISS) was higher in Group A in comparison to Group B (18 ± 11 vs 13 ± 8; P = 0.02). Presence of pain and seatbelt sign ( P = 0.02) were evident in Group B. Hypotension ( P = 0.004) and hypothermia ( P = 0.01) were prominent in Group A. The rate of positive Focused Assessment Sonography for Trauma was greater in Group A ( P = 0.001). Among operative findings, bowel perforation was more frequent in Group B ( P = 0.04), whereas mesenteric full-thickness hematoma was significantly higher in Group A. Pelvic fracture was more frequent finding in Group A ( P = 0.005). The overall mortality rate was 15.6 per cent. In patients with BAT, the presence of abdominal pain, hypotension, ISS greater than 16, hypothermia, pelvic fracture, and mesenteric hematoma might help in early diagnosis of BBMI. Moreover, base deficit and mean ISS were independent predictors of mortality. Delayed operative interventions greater than 8 hours increased morbidity rate but had no significant impact on mortality.

Dilemma of blunt bowel injury: what are the factors affecting early diagnosis and outcomes

Blunt bowel and mesenteric injury (BBMI) is frequently a difficult diagnosis at initial presentation. We aimed to study the predictors for early diagnosis and outcomes in patients with BBMI. Data were collected retrospectively from the database registry between January 2008 and December 2011 in the only Level I trauma unit in Qatar. Patients with BBMI were divided into Group A (surgically treated within 8 hours) and Group B (treated after 8 hours). Data were analyzed and χ2, Student's t test, and multivariate regression analysis were performed appropriately. Among 984 patients admitted with blunt abdominal trauma (BAT), 11 per cent had BBMI with mean age of 35 ± 9.5 years. Polytrauma and isolated bowel injury were identified in 53 and 42 per cent, respectively. Mean Injury Severity Score (ISS) was higher in Group A in comparison to Group B (18 ± 11 vs. 13 ± 8; P = 0.02). Presence of pain and seatbelt sign (P = 0.02) were evident in Group B. Hypotension (P = 0.004) and hypothermia (P = 0.01) were prominent in Group A. The rate of positive Focused Assessment Sonography for Trauma was greater in Group A (P = 0.001). Among operative findings, bowel perforation was more frequent in Group B (P = 0.04), whereas mesenteric full-thickness hematoma was significantly higher in Group A. Pelvic fracture was more frequent finding in Group A (P = 0.005). The overall mortality rate was 15.6 per cent. In patients with BAT, the presence of abdominal pain, hypotension, ISS greater than 16, hypothermia, pelvic fracture, and mesenteric hematoma might help in early diagnosis of BBMI. Moreover, base deficit and mean ISS were independent predictors of mortality. Delayed operative interventions greater than 8 hours increased morbidity rate but had no significant impact on mortality.