Blunt hepatic and splenic trauma. A single Center experience using a multidisciplinary protocol.

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Critical Care

Background:

• Blunt abdominal trauma frequently involves solid organs like the liver, spleen, and kidneys.
• Hemodynamic stability is a critical factor in determining the management strategy for abdominal organ injuries.
• Established protocols are essential for consistent patient care in trauma centers.

Purpose of the Study:

• To evaluate the outcomes of nonoperative management for abdominal organ injuries in hemodynamically stable patients.
• To describe over a decade of experience from a single trauma center regarding this management approach.
• To assess the role of institutional criteria in guiding therapeutic decisions.

Main Methods:

• Retrospective analysis of 732 patients with blunt abdominal trauma admitted between 2001 and 2014.
• Application of an institutional protocol assessing hemodynamic stability via fluid challenge response.
• Classification of patients into three categories (A, B, C) based on their response to treatment.

Main Results:

• 51.4% of patients (376) were managed nonoperatively, while 48.6% (356) underwent surgery.
• Overall mortality was 9.8%; 4.5% in the nonoperative group versus 15.4% in the surgical group.
• Patients over 40 years old had significantly higher mortality rates.

Conclusions:

• Nonoperative management is a viable strategy for hemodynamically stable patients with abdominal organ injuries, achieving a low mortality rate (4.5%).
• Hemodynamic stability, not the AAST Organ Injury Scale, emerged as the primary criterion for selecting nonoperative management.
• Strict adherence to institutional protocols is crucial for successful nonoperative management in trauma care.