Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Journal of Trauma Management & Outcomes

Paal Aksel Naess¹  Nils Oddvar Skaga³  Torsten Eken³  Christine Gaarder¹  Sigrid Groven² 

[1] Department of Traumatology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Nydalen, PO Box 4956, Oslo N-0424, Norway;Department of Surgery, Vestre Viken HF Drammen Hospital, Oslo, Norway;Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway

关键词: Survival;    Variable life-adjusted display;    Performance improvement;    Non-operative management;    Laparotomy;    Abdominal injury;    Trauma;   

Others  :  1133131
DOI  :  10.1186/1752-2897-8-9

 received in 2013-11-24, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Introduction

Damage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period.

Methods

Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared.

Results

There was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period.

Conclusion

Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM.

【 授权许可】

   
2014 Groven et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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