Is it safe to discharge blunt abdominal trauma patients with normal initial findings?
PURPOSE penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT. METHODS the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups: "Healthy Group" (HG) (n = 942) and "Deathly Group" (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multivariate analyses. RESULTS a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01+/-63.9 (14-74) years and 30+/-12.5(15-71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09+/-1.3 (0.5-3) and 6.9+/-11.4 (1-6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98+/-1.08 (1-7) and 4.67+/-1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78+/-9.44 (1-58) and 46.24+/-22.18 (15-119) in the HG and DG respectively (p = 0.000). In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03-38.12, P = 0.000], the long IBIO (OR = 1.82, CI = 1.39-2.40, P = 0.000), PSDA (OR = 94.45, CI = 28.32-314.95, P = 0.000), presence of cranial injury (OR = 0.03, CI = 0.002-0.363, P = 0.006) and high PATI (OR = 1.14, CI = 1.09-1.19, P = 0.000), were found significantly important for mortality. CONCLUSION we determined that conditions such as, female gender, long interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.