Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Groven, Sigrid; Gaarder, Christine; Eken, Torsten; Skaga, Nils Oddvar; Næss, Paal Aksel

doi:10.1186/1752-2897-8-9

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…Although the incidence of unnecessary laparotomies has decrease due to improvements in imaging, they are still present in trauma centres, with 3.6% negative laparotomies, more frequent in stab injuries, and 6-27% nontherapeutic laparotomies, with complication rates up to 14.5% and 12% respectively. For BAT, the incidence of non-therapeutic laparotomies in Europe reaches 27% (11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

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Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.

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Section: Discussionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

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“…In the past decades, it is suggested that the exposure of most European surgeons to an emergency laparotomy in severely injured patients is declining [1]. Penetrating injuries are a frequent indication for laparotomy in trauma patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, most blunt trauma patients can nowadays be managed by non-operative management (NOM) [1,4,5]. This is in contrast to countries such as the USA and South Africa where exposure is higher due to high-volume presentation of trauma patients with penetrating abdominal injuries [1,3,6,7]. The current challenge is to provide an adequate level of care with satisfactory outcome for trauma patients who require an emergency laparotomy in Europe [8].…”

Section: Introductionmentioning

confidence: 99%

Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization

et al. 2019

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Background: Far reaching sub-specialization tends to become obligatory for surgeons in most Western countries. It is suggested that exposure of surgeons to emergency laparotomy after trauma is ever declining. Therefore, it can be questioned whether a generalist (i.e., general surgery) with additional differentiation such as the trauma surgeon, will still be needed and can remain sufficiently qualified. This study aimed to evaluate volume trends and outcomes of emergency laparotomies in trauma. Methods: A retrospective cohort study was performed in the University Medical Center Utrecht between January 2008 and January 2018, in which all patients who underwent an emergency laparotomy for trauma were included. Collected data were demographics, trauma-related characteristics, and number of (planned and unplanned) laparotomies with their indications. Primary outcome was in-hospital mortality; secondary outcomes were complications, length of ICU, and overall hospital stay. Results: A total of 268 index emergency laparotomies were evaluated. Total number of patients who presented with an abdominal AIS > 2 remained constant over the past 10 years, as did the percentage of patients that required an emergency laparotomy. Most were polytrauma patients with a mean ISS = 27.5 (SD ± 14.9). The most frequent indication for laparotomy was hemodynamic instability or ongoing blood loss (44%).Unplanned relaparotomies occurred in 21% of the patients, mostly due to relapse of bleeding. Other complications were anastomotic leakage (8.6%), intestinal leakage after bowel contusion (4%). In addition, an incisional hernia was found in 6.3%. Mortality rate was 16.7%, mostly due to neurologic origin (42%). Average length of stay was 16 days with an ICU stay of 5 days. Conclusion: This study shows a persistent number of patients requiring emergency laparotomy after (blunt) abdominal trauma over 10 years in a European trauma center. When performed by a dedicated trauma team, this results in acceptable mortality and complication rates in this severely injured population.

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“…Penetrating injury is infrequent in most western European countries, whereas higher rates are seen in the US and South Africa [26,27]. In the Northern European countries, penetrating trauma is seen in 5-14% [28][29][30][31][32], and 37-58% [29,33,34] for patients undergoing trauma laparotomy, with gunshots accounting for 5-36% [28,[35][36][37][38]. In our study, penetrating trauma accounted for 16,6% of the trauma population and 66.3% for patients undergoing laparotomy.…”

Section: Discussionmentioning

confidence: 56%

A characterization of trauma laparotomies in a scandinavian setting: an observational study

Bentin

Possfelt-Møller

Svenningsen

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Despite treatment advances, trauma laparotomy continuous to be associated with significant morbidity and mortality. Most of the literature originates from high volume centers, whereas patient characteristics and outcomes in a Scandinavian setting is not well described. The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a Scandinavian setting and compare this to international reports. Methods A retrospective study was performed in the Copenhagen University Hospital, Rigshospitalet (CUHR). All patients undergoing a trauma laparotomy within the first 24 h of admission between January 1st 2019 and December 31st 2020 were included. Collected data included demographics, trauma mechanism, injuries, procedures performed and outcomes. Results A total of 1713 trauma patients were admitted to CUHR of which 98 patients underwent trauma laparotomy. Penetrating trauma accounted for 16.6% of the trauma population and 66.3% of trauma laparotomies. Median time to surgery after arrival at the trauma center (TC) was 12 min for surgeries performed in the Emergency Department (ED) and 103 min for surgeries performed in the operating room (OR). A total of 14.3% of the procedures were performed in the ED. A damage control strategy (DCS) approach was chosen in 18.4% of cases. Our rate of negative laparotomies was 17.3%. We found a mortality rate of 8.2%. The total median length of stay was 6.1 days. Conclusion The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort is comparable to reports from similar Western European trauma systems.

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Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Cited by 8 publications

References 31 publications

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization

A characterization of trauma laparotomies in a scandinavian setting: an observational study

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