Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy.

Scand J Surg 2019 Feb 20:1457496919828244. Epub 2019 Feb 20.

1 Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Background And Aims:: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon.

Materials And Methods:: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated.

Results:: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4).

Conclusion:: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

Download full-text PDF

Source
http://dx.doi.org/10.1177/1457496919828244DOI Listing
February 2019
1 Read

Article Mentions


Provided by Crossref Event Data
twitter
Twitter:
March 2, 2019, 3:58 pm EST
twitter
Twitter:
March 2, 2019, 1:47 pm EST
twitter
Twitter:
February 22, 2019, 4:43 am EST

Publication Analysis

Top Keywords

blunt abdominal
20
abdominal trauma
20
complex skills
12
emergency laparotomy
8
skill set
8
trauma patients
8
set general
8
trauma
7
blunt
5
abdominal
5
patients
5
emergency procedures
4
trauma performed
4
procedures needed
4
performed skill
4
needed blunt
4
general surgeons
4
aim study
4
required complex
4
patients sub-specialized
4

References

(Supplied by CrossRef)
Article in Crit Care
Kauvar DS et al.
Crit Care 2005
Article in Clin Pract
Mehta N et al.
Clin Pract 2014
Article in J Trauma
Clarke JR et al.
J Trauma 2002
Article in Scand J Trauma Resusc Emerg Med
Soreide K et al.
Scand J Trauma Resusc Emerg Med 2009
Article in Br J Anaesth
McCullough AL et al.
Br J Anaesth 2014
Article in J Am Coll Surg
Harvin JA et al.
J Am Coll Surg 2017
Article in World J Surg
Doll D et al.
World J Surg 2017
Article in J Emerg Trauma Shock
Ahmed N et al.
J Emerg Trauma Shock 2011
Article in J Trauma
Lavoie A et al.
J Trauma 2004
Article in Emerg Med Clin North Am
Isenhour JL et al.
Emerg Med Clin North Am 2007

Similar Publications