Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication

Journal of Trauma Management & Outcomes

Rifat Latifi¹  Ruben Peralta³  Ashok Parchani³  Ahmad Zarour³  Hassan Al-Thani³  Husham Abdelrahman³  Ayman El-Menyar² 

[1] Department of Surgery, University of Arizona, Tucson, AZ, USA;Internal Medicine, Ahmed Maher teaching Hospital, Cairo, Egypt;Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar

关键词: Mortality;    Anatomical compartment;    Abdominal injury;    Trauma;   

Others  :  1132878
DOI  :  10.1186/1752-2897-8-14

 received in 2014-03-11, accepted in 2014-09-12,  发布年份 2014

【 摘 要 】

Background

The mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments.

Patients & methods

We conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed.

Results

Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29 ± 13) and highest in TAC (34 ± 11) group, (P = 0.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; P = 0.001) and need for blood transfusion (OR 3.03; P = 0.003) were the main independent predictors of mortality.

Conclusion

In addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification.

【 授权许可】

   
2014 El-Menyar et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR: Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Inj Prev 2010, 11:353-360.
• [2]Bonatti H, Calland JF: Trauma. Emerg Med Clin North Am 2008, 26(3):625-648.
• [3]Burgut HR, Bener A, Sidahmed H, Albuz R, Sanya R, Khan WA: Risk factors contributing to road traffic crashes in a fast-developing country: the neglected health problem. Ulus Travma Acil Cerrahi Derg 2010, 16(6):497-502.
• [4]Mamtani R, Al-Thani MH, Al-Thani AA, Sheikh JI, Lowenfels AB: Motor vehicle injuries in Qatar: time trends in a rapidly developing Middle Eastern nation. Inj Prev 2012, 18(2):130-132.
• [5]Musau P, Jani PG, Owillah FA: Pattern and outcome of abdominal injuries at Kenyatta National Hospital. Nairobi East Afr Med J 2006, 83(1):37-43.
• [6]Sido B, Grenacher L, Friess H, Büchler MW: Abdominal trauma. Orthopade 2005, 34(9):880-888.
• [7]Staib L, Henne-Bruns D: New observations on gut trauma. Chirurg 2005, 76(10):927-934.
• [8]Legome EL, Keim SM, Salomone JP, Dunn E, Talavera F, Sheridan E, Udeani J: Blunt Abdominal Trauma. Available from : http://emedicine.medscape.com/article/1980980-overview webcite. Accessed at 22 August 2013
• [9]Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM: Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. North Am J Med Sci 2012, 4(3):129-134.
• [10]Aldemir M, Tacyildiz I, Girgin S: Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg 2004, 104:429-434.
• [11]Smith J, Caldwell E, D’Amours S, Jalaludin B, Sugrue M: Abdominal trauma: A disease in evolution. ANZ J Surg 2005, 75:790-794.
• [12]Santiago LA, Oh BC, Dash PK, Holcomb JB, Wade CE: A clinical comparison of penetrating and blunt traumatic brain injuries. Brain Inj 2012, 26(2):107-125.
• [13]Lone GN, Peer GQ, Warn AK, Bhat AM, Warn NA, Bhat MA: An experience with abdominal trauma in adults in Kashmir. JK Pract 2001, 8:225-230.
• [14]Lund H, Kofoed SC, Hillingsø JG, Falck-Larsen C, Svendsen LB: High mortality after emergency room laparotomy in haemodynamically unstable trauma patients. Dan Med Bull 2011, 58:A4275.