Determinants of morbidity and mortality in blunt abdominal trauma

We reviewed retrospectively 260 consecutive patients operated upon for blunt abdominal trauma in a 7-year period; there were 318 injured organs and 40 deaths, giving a mortality of 15%. The injuries with the highest mortality were duodenal, vascular, hepatic, pancreatic, and gastrointestinal perforations; splenic, small bowel and gallbladder trauma had the lowest mortality. Almost half of the fatal cases but less than a quarter of the survivors had two or more non-abdominal injuries and 72% of the survivors but only 32% of the non-survivors had two or more injured abdominal organs. Diagnostic procedures were obtained preoperatively in 98% of the patients; about half of these were positive but only 12% were specifically diagnostic of a particular organ injury. Using the correct organ and the correct injury as the criteria, half of the cases were correctly diagnosed preoperatively, although all of the patients were judged to have some form of significant abdominal trauma. Delays from attempts to establish a precise preoperative diagnosis contributed to increased morbidity and mortality, particularly in patients who were haemodynamically unstable. After a Trauma Unit was established, the time from admission of patients to hospital until operation and the overall mortality were significantly reduced, particularly for those with hypotension.