Predictors of morbidity after traumatic pancreatic injury

Although relatively uncommon, traumatic pancreatic injury is associated with significant morbidity and mortality. The objectives of this review were to validate the American Association for the Surgery of Trauma organ injury grading system for pancreatic injury by defining its relationship to subsequent morbidity and to characterize the independent predictors of postoperative complications.

We undertook a retrospective review of all patients with a pancreatic injury, confirmed by laparotomy, admitted to our Level I trauma center from 1986 and 1999. Pancreatic injury severity was assessed on the basis of the operative report. Outcome parameters included mortality, pancreatic complications (pancreatic fistula, pseudocyst, pancreatitis), intensive care unit (ICU) complications (acute respiratory distress syndrome, pneumonia, renal failure, multiple organ failure syndrome), abdominal complications (abscess, wound infection, ventral hernia, enteric fistula), and length of stay.

There were 193 patients identified. Mortality was 12%. Overall morbidity in the series was 50%, with a 22% prevalence of pancreas-related complications. Multivariate analysis revealed that the grade of pancreatic injury was an independent predictor of both pancreatic complications (odds ratio, 4.4; 95% confidence interval, 1.9-10) and mortality (odds ratio, 2.6; 95% confidence interval, 1.2-5.8). Pancreatic and ICU complications were associated with longer ICU and hospital stays.

The American Association for the Surgery of Trauma Organ Injury Score predicts the development of complications and mortality after pancreatic injury and identifies patients who will require extensive resources and may benefit from transfer to a Level I trauma center.