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Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm

Matthias Heuer1, Björn Hussmann, Rolf Lefering

  • 1Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, NRW, Germany.

Langenbeck'S Archives of Surgery
|August 18, 2011
PubMed

Insights

Pancreatic trauma is present in 3.1% of severely injured patients with abdominal injuries. Higher grades of pancreatic injury (IV and V) significantly increase mortality and the need for surgical intervention.

Area of Science:

  • Trauma Surgery
  • Surgical Outcomes
  • Abdominal Trauma

Background:

  • Pancreatic trauma is a severe injury with significant morbidity and mortality.
  • The prevalence and outcomes of pancreatic trauma in severely injured patients require further investigation.

Purpose of the Study:

  • To assess the prevalence of pancreatic trauma in severely injured patients.
  • To analyze the outcomes of pancreatic trauma in relation to injury severity.
  • To evaluate the established treatment algorithm for pancreatic trauma.

Main Methods:

  • Retrospective analysis of 51,425 patients from the Trauma Register of the German Society of Trauma Surgery (TR DGU) (1993-2009).
  • Inclusion criteria: Injury Severity Score (ISS) ≥16, direct trauma center admission, ≥3 days treatment, age ≥16, and abdominal injury (Abbreviated Injury Scale [AIS](abdomen) ≥2).
  • Comparison of patients with abdominal trauma versus those with additional pancreatic trauma (AIS(pancreas) 2-5).

Main Results:

  • 18% of patients had documented abdominal injuries; 3.1% of these had associated pancreatic injuries.
  • Pancreatic injury prevalence: AAST grades II (1.9%), III (0.6%), IV (0.3%), and V (0.2%).
  • High-grade pancreatic injuries (AAST IV and V) correlated with significantly increased mortality (30.0% and 33.3%, respectively) and surgical intervention rates (80.6% and 81.8%, respectively).

Conclusions:

  • This study provides the first comprehensive data on the prevalence and outcomes of pancreatic injury in a large cohort from the TR DGU.
  • A treatment algorithm for pancreatic trauma has been developed based on current literature and study findings.
  • Severe pancreatic trauma necessitates aggressive management due to high mortality and surgical intervention rates.
Abstract

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