An Exploration of Challenges in Routine Emergency Care With Delayed Presentations of Blunt Abdominal Trauma

Delayed presentation among patients with blunt abdominal trauma (BAT) constitutes one of the biggest challenges in the emergency care field, particularly in low-resource regions. Delays may increase the risk of developing intra-abdominal infections, increase the need for surgical procedures, and deteriorate the overall outcomes. The purpose of this study was to determine the prevalence of delayed presentations, major predisposing factors, and their contribution to complications in BAT patients.

It was a prospective observational study conducted over six months using a sample of 120 patients who presented to the emergency department with a BAT. Patients were divided into two groups based on time for presentation: early (less than six hours of injury, n = 83) and delayed presenters (greater than six hours, n = 37). Information regarding demographics, mechanism of injury, clinical signs, diagnostics, treatment modalities, complications, and outcomes was gathered. The effects of delay on morbidity and mortality were evaluated. Utilizing Statistical Package for the Social Sciences version 26.0 (IBM Corp., Armonk, NY), the chi-square tests were performed on the categorical variables and independent t-tests on the continuous variables. A p value of <0.05 was used for significance.

Around one-third of the patients presented late. The most important contributing factors included lack of awareness, 16 (43.2%), transportation issues, 10 (27.0%), and first treatment with nonspecialist providers, seven (18.9%), all of which were indicative of long delays (p < 0.05). The delayed presenters were associated with increased intra-abdominal infections, nine (24.3%) vs. seven (8.4%), p = 0.011, and surgical intervention, 22 (59.5%, confidence interval, CI: 43.5-73.7) vs. 31 (37.3%, CI: 27.7-48.1), p = 0.021.

The risk of complications and operative requirements in patients with BAT is largely determined by time to hospital presentation. To minimize unnecessary delays, community education, emergency transportation, and simplified referral are often essential.