Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Non-operative management of blunt abdominal solid organ trauma in adult patients

Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Non-operative management of blunt abdominal solid organ trauma in adult patients

Blunt abdominal trauma
Operative
Non-operative management
Solid organs

Introduction: Despite agreement in the literature that “stable” blunt trauma patients may be managed con-
servatively, in Egypt many such patients receive operative management. This paper presents the results of a

pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP)
management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta
University Emergency Hospital (TUH) in Egypt.
Methods: A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ
injury at TUH over a 3-year period (June 2014–June 2017). Inclusion criteria were age ≥18 yr, mean arterial
pressure > 65 mm Hg, heart rate < 110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by

ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-
tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-
tients were assigned to non-operative or operative management based on clinician preference. Outcomes of

interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ2 were
used to compare outcomes.
Results: During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal
trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10
– NOP vs. 28 ± 11 – OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP]
vs.1155.17 ± 380.4 ml [OP] (p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs.
6.45 ± 1.97 days [OP] (p = 0.012)). There was no difference in mortality between groups (p = 0.091).
Conclusion: Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was
safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer
length of stay for non-operative patients might reflect treating physician caution in their management.

Wesam Ibrahim, Gamal Mousa, Jon Mark Hirshon, Mohamed El-Shinawi, Hani Mowafi

https://doi.org/10.1016/j.afjem.2020.02.002

17 February 2020

peri irawan

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