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Risk factors of delayed diagnosis of pancreatic trauma
A K Leppäniemi1, R K Haapiainen
1Second Department of Surgery, Helsinki University Central Hospital, Finland.
Objective:
To identify risk factors associated with delayed diagnosis of pancreatic injuries.
Design:
Retrospective study.
Setting:
University hospital, Finland.
Patients:
31 patients treated for pancreatic injuries from January 1986 to April 1998.
Interventions:
Clinical, laboratory, and radiological assessment. Initial management operative (n = 22) and non-operative (n = 9).
Main Outcome Measures:
Timely or delayed (>12 hours after injury) recognition of pancreatic trauma.
Results:
Blunt trauma (7/17 timely and 12/14 delayed diagnosis, p = 0.03), intoxication on admission (4/10 compared with 5/5 patients studied, p < 0.05), low New Injury Severity Score (median, interquartile 34, 11.5-41 compared with 14.5, 10-25, p = 0.02), low Abdominal Trauma Index (38, 20-54 compared with 16.5 15-24, p = 0.01), absence of associated abdominal organ injuries (1/17 compared with 8/14, p = 0.004), and initial nonoperative management (2/17 compared with 7/14, p = 0.04) were significant risk factors of delayed diagnosis of pancreatic trauma. The main reasons for the delay in diagnosis were missed pancreatic injury at initial operation (n = 4, 2 penetrating), failure to exclude blunt pancreatic injury before non-operative management (n = 4), delay in presentation (n = 3), underestimation of the severity of pancreatic injury on initial computed tomogram (n = 2), and missed diagnosis of blunt duodenal rupture with mild pancreatic injury (n = 1).
Conclusions:
In patients with blunt abdominal trauma and altered consciousness with few clinical signs, and no or mild associated abdominal injuries, we recommend additional diagnostic studies to exclude pancreatic rupture before starting non-operative management. Exposure and evaluation of the pancreas during laparotomy for trauma is essential.