Laparotomy for trauma in a regional centre: the effect of delay on outcome

From 1983 to 1990, 110 patients with abdominal trauma required laparotomy in the Albury-Wodonga region. Splenic and liver injuries occurred in 50% of cases, and bowel trauma in 20%. The mortality rate was 8.2% (nine deaths) and major postoperative complications occurred in 18 patients (16%). Delay in therapeutic intervention of greater than 4 h from hospital admission led to a statistically significant increase in the complication rate (P < 0.01) despite a lower injury severity score in this group. Delayed repair of bowel injuries in particular led to an 80% major complication rate in survivors. A high index of clinical suspicion and the regular use of diagnostic peritoneal lavage is suggested to avoid such delays in diagnosis and subsequent surgery.