Hollow viscus injuries: predictors of outcome and role of diagnostic delay
Received 4 March 2017
Accepted for publication 10 June 2017
Published 23 August 2017 Volume 2017:13 Pages 1069—1076
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 4
Editor who approved publication: Professor Garry Walsh
Andrea Mingoli,1,2 Marco La Torre,1,2 Gioia Brachini,1,2 Gianluca Costa,3 Genoveffa Balducci,3 Barbara Frezza,3 Giovanna Sgarzini,4 Bruno Cirillo1,2
1Emergency Department, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; 2Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; 3Surgical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 4Department of Surgery, S Giovanni Addolorata Hospital, Rome, Italy
Introduction: Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.
Methods: From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.
Results: Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.
Conclusion: There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.
Keywords: bowel injuries, hollow viscus injuries, abdominal blunt trauma, trauma, traumatic bowel perforation, BIPS
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