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Solid Viscus Injury Predicts Major Hollow Viscus Injury in Blunt Abdominal Trauma

Nance, Michael L. MD; Peden, Gerald W. MD; Shapiro, Michael B. MD; Kauder, Donald R. MD; Rotondo, Michael F. MD; Schwab, C. William MD

Journal of Trauma and Acute Care Surgery: October 1997 - Volume 43 - Issue 4 - p 618-623

Background  As nonoperative management of blunt abdominal trauma has become more popular, reliable models for predicting the likelihood of concomitant hollow viscus injury in the hemodynamically stable patient with a solid viscus injury are increasingly important.

Methods  The Pennsylvania Trauma Systems Foundation registry was reviewed for the period from January 1992 to December 1995 for all adult (age > 12 years) patients with blunt trauma and an Abbreviated Injury Scale (AIS) score >or=to 2 for a solid viscus (kidney, liver, pancreas, spleen). Patients with an initial systolic blood pressure < 90 mm Hg were excluded. Hollow viscus injuries included only lacerations or perforations of the gallbladder, gastrointestinal tract, or urinary tract.

Results  In the 4-year period, 3,089 patients sustained solid viscus injuries, 296 of whom had a hollow viscus injury (9.6%). The mean age was 35.6 years, mean Injury Severity Score was 22.2, and mean Revised Trauma Score was 7.3; 63.3% of the patients were male. A solitary solid viscus injury occurred in 2,437 patients (79%), 177 of whom (7.3%) had a hollow viscus injury. The frequency of hollow viscus injury increased with the number of solid organs injured: 15.4% of patients with two solid viscus injuries (n = 547) and 34.4% of patients with three solid viscus injuries (n = 96) suffered a concomitant hollow viscus injury (p < 0.001 vs. one organ). A hollow viscus injury was 2.3 times more likely for two solid viscus injuries and 6.7 times more likely for three solid viscus injuries compared with a solitary solid viscus injury. For solitary solid viscus injury, the frequency of hollow viscus injury varied little with increasing AIS score (AIS score 2, 6.6%; AIS score 3, 8.2%; AIS score 4, 9.2%; AIS score 5, 6.2%) (p = 0.27 between groups), suggesting that the incidence of hollow viscus injury is related more to the number of solid visceral injuries than the severity of individual organ injury. Also, when the sum of the AIS scores for solid viscus injuries was <6, the mean rate of hollow viscus injury was 7.8%. This increased to 22.8% when the sum of the AIS scores for solid viscus injury was >or=to6 (p < 0.001). A pancreatic injury in combination with any other solid viscus injury had a rate of hollow viscus injury of >33%.

Conclusion  A model of organ injury scaling predicted hollow viscus injury. Multiple solid viscus injuries, particularly pancreatic, or abdominal solid viscus injuries with an AIS score >or=to 6, were predictive of hollow viscus injury. Identification of these injury patterns should prompt consideration for early operative intervention.

From the Department of Surgery (M.L.N.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the Department of General Surgery (G.W.P.), Lankenau Hospital, Wynnewood, Pennsylvania; and the Division of Trauma and Surgical Critical Care (M.B.S., D.R.K., M.F.R., C.W.S.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

Presented at the 56th Annual Meeting of the American Association for the Surgery of Trauma, September 19-21, 1996, Houston, Texas.

Address for reprints: C. William Schwab, MD, Division of Trauma and Surgical Critical Care, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104.

© Williams & Wilkins 1997. All Rights Reserved.