Prognostic factors, morbidity and mortality in pancreatic trauma: A critical appraisal of 432 consecutive patients treated at a Level 1 Trauma Centre

Krige, J. E. J.; Kotze, U.; Setshedi, Mashiko; Nicol, Andrew; Navsaria, Pradeep

doi:10.1016/j.injury.2015.01.032

Cited by 47 publications

(57 citation statements)

References 21 publications

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“…Major injuries to the pancreas remain a significant source of morbidity even when treated in well-resourced high-volume specialist trauma referral centers[21,22,27]. Outcome is influenced by the mechanism, anatomical location, grade and complexity of the pancreatic injury, the amount of blood lost, duration of hypovolemic shock, the quality of resuscitation, number of associated injuries and the appropriateness and quality of surgical intervention[3,15,27,28]. Overall reported morbidity rates following pancreatic injury range from 30% to 70% with the higher reported percentages generally being the result of severe trauma with higher AAST grades, associated injuries, diagnostic delay and inadequate or inappropriate initial treatment[15,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Our group has previously evaluated other aspects of pancreatic trauma and, as one of the world’s busiest high volume academic trauma centers, has sufficient prospective granular data available to investigate organ-specific research questions[12-15]. The aim of this research project was to provide a detailed analysis to benchmark the severity of complications after pancreatic resection for severe trauma in a civilian patient population using the ASGS.…”

Section: Introductionmentioning

confidence: 99%

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Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

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AIMTo benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.METHODSA prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.RESULTSOverall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.CONCLUSIONThis ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…Pancreatic trauma is associated with a high mortality and morbidity. Determining factors are the presence of associated injuries to nearby organs, vessels or bile duct, the presence of shock and time to surgery [5, 6]. Complications include fistulas, infections, pseudocysts and abscesses [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow

et al. 2016

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Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption.

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“…They correctly remark that the management strategy for isolated injuries cannot be applied to all situations nor is it intended to be so. For a comprehensive pancreatic injury management strategy, we refer readers to our previous publications [1,2]. In this study under discussion, thirty-four patients who had an acute abdomen with signs of peritonitis and a clear mandate for urgent intervention underwent immediate surgery after appropriate resuscitation [3].…”

mentioning

confidence: 99%

Isolated injury to the pancreas: The importance of the baseline computed tomography scan

Kotze

Nicol

Navsaria

2016

Journal of Visceral Surgery

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Prognostic factors, morbidity and mortality in pancreatic trauma: A critical appraisal of 432 consecutive patients treated at a Level 1 Trauma Centre

Cited by 47 publications

References 21 publications

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow

Isolated injury to the pancreas: The importance of the baseline computed tomography scan

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