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Blunt Aortic Injury with Concomitant Intra-abdominal Solid Organ Injury: Treatment Priorities Revisited
- Source :
- The Journal of Trauma: Injury, Infection, and Critical Care. 53:442-445
- Publication Year :
- 2002
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2002.
-
Abstract
- Patients with blunt aortic injury (BAI) often have concomitant liver or spleen (L/S) injuries. With increasing use of cardiopulmonary bypass with heparinization in repair of BAI, many advocate operative management of the L/S injury before aortic repair to eliminate risk of hemorrhage. We evaluated the safety of nonoperative management (NOM) of blunt L/S injuries in patients undergoing acute BAI repair with bypass.All patients admitted over a 6-year period with BAI were identified from the registry of our Level I trauma center. Patients with isolated L/S injuries without BAI admitted over the same period served as controls. Groups were compared with regard to demographics, injury characteristics, hospital course, and mortality.Eighty-four patients were diagnosed with BAI from 1994 to 2000; 28 (33%) also had blunt abdominal trauma. Three patients with severe brain injury did not undergo BAI repair, and five required laparotomy before BAI repair for other intra-abdominal injuries (two for hemodynamic instability with splenic injury, and three for concomitant bowel injury). Therefore, 20 of 28 (71.4%) BAI patients with grade I or II L/S injury (Aorta L/S group) underwent planned NOM. All BAIs were repaired using partial bypass with full heparinization. These 20 patients are compared with 894 patients with grade I or II L/S injuries with no BAI (L/S group) over the same time period. There was no difference in the nonoperative failure rate of the Aorta L/S group versus the L/S group (0% vs. 1.7%). Both groups had similar complication rates. The Aorta L/S group was also compared with 56 BAIs without solid organ injury (Aorta group). Although the Aorta L/S group was more severely injured than the Aorta group (Injury Severity Score of 35.3 vs. 26.8,0.0001), transfusion rates (5.7 U of packed red blood cells vs. 8.0 U of packed red blood cells, p = NS), hospital days (17.9 vs. 19.1, p = NS) and mortality (10% vs. 9%, p = NS) were similar.NOM of patients with grade I or II L/S injury who undergo systemic anticoagulation with heparin for repair of BAI is safe and associated with transfusion rates similar to BAI alone. Patients with low-grade liver or spleen injuries do not require laparotomy before BAI repair using partial bypass.
- Subjects :
- Adult
Male
medicine.medical_specialty
Critical Care
Aorta, Thoracic
Abdominal Injuries
Wounds, Nonpenetrating
Critical Care and Intensive Care Medicine
Medical Records
law.invention
Injury Severity Score
Postoperative Complications
Trauma Centers
law
medicine.artery
Outcome Assessment, Health Care
Cardiopulmonary bypass
Humans
Medicine
Retrospective Studies
Aorta
Multiple Trauma
business.industry
Vascular disease
medicine.disease
Tennessee
Surgery
Radiography
medicine.anatomical_structure
Liver
Abdominal trauma
Anesthesia
Abdomen
Female
business
Packed red blood cells
Complication
Spleen
Subjects
Details
- ISSN :
- 00225282
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- The Journal of Trauma: Injury, Infection, and Critical Care
- Accession number :
- edsair.doi.dedup.....3f239f6a75739011272df041d7897014
- Full Text :
- https://doi.org/10.1097/00005373-200209000-00008