Relatively Short Diagnostic Delays (&lt;8 Hours) Produce Morbidity and Mortality in Blunt Small Bowel Injury: An Analysis of Time to Operative Intervention in 198 Patients from a Multicenter Experience

Fakhry, Samir M.; Brownstein, Michelle R.; Watts, Dorraine D.; Baker, Christopher C.; Oller, Dale

doi:10.1097/00005373-200003000-00007

Cited by 330 publications

(284 citation statements)

References 13 publications

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“…The delay in diagnosis and treatment is associated with increased morbidity and mortality (15). Intestinal injury may be diagnosed in the late period following trauma.…”

Section: Discussionmentioning

confidence: 99%

The conservative management of abdominal injuries

Okuş

Sevinç

et al. 2014

UCD

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Objective: Non-operative management of abdominal injuries has recently become more common. Especially nonoperative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of nonoperative treatment in abdominal trauma (blunt penetrating) is discussed. Material and Methods:All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. Results:The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. Conclusion:Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring.

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“…The delay in diagnosis and treatment is associated with increased morbidity and mortality (15). Intestinal injury may be diagnosed in the late period following trauma.…”

Section: Discussionmentioning

confidence: 99%

The conservative management of abdominal injuries

Okuş

Sevinç

et al. 2014

UCD

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“…Delays in diagnosis of as much as 8 h [21], or in one study 5 h [6] is responsible for increased morbidity and mortality in patients with bowel and mesenteric injury. However, Thompson et al [22] report no such findings in a study of 13 children out of which 09 were because of motor vehicular accidents.…”

Section: Discussionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.

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“…Sharma and coworkers [159] found missed injuries in 58% of the analyzed autopsies, with negative impact on survival in 3% of them. Hollow viscus perforation is infrequent in blunt trauma [160], but delays in diagnosis and treatment result in a significant increase in morbidity and mortality [161]. Hemorrhage has been reported between 18% and 25% of all preventable deaths, some of them corresponding to an intracavital bleeding not timely recognized [8,155,162].…”

Section: Missed Injuries and Tertiary Surveymentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Relatively Short Diagnostic Delays (<8 Hours) Produce Morbidity and Mortality in Blunt Small Bowel Injury: An Analysis of Time to Operative Intervention in 198 Patients from a Multicenter Experience

Cited by 330 publications

References 13 publications

The conservative management of abdominal injuries

The conservative management of abdominal injuries

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Critical Care Issues in the Early Management of Severe Trauma

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