Muhammad Yousuf Shaikh, Arshad Beg and Sheeraz ur Rehman
Introduction: Trauma represents a major cause of death in patients presenting in emergency department. Abdomen represents a commonly injured region which may often by missed in cases of blunt trauma particularly when compounded with other obvious musculoskeletal injuries. The role of trauma team is to assess, resuscitate and manage all poly-trauma patients in a systematic manner to avoid missing intra-abdominal injuries and manage such patients aggressively.
Materials and methods: This retrospective study was conducted in Liaquat National Hospital, Karachi which is a level 2 trauma centre. All the data was obtained from the hospital’s registry for the period of 1 year from January 2014 to December 2014. Trauma victims who fulfilled trauma team activation criteria were included in study with criteria like patients with abdominal trauma with obvious penetrating injury either in the form of gunshot injury, stab wound or any object penetrating the abdomen with or without an exit wound; patients with blunt trauma with ultrasound Fast/CT scan showing free fluid, hemoperitoneum or visceral injury; adult patients more than 18 years of age; poly trauma patients with associated abdominal injury. Patients excluded from study were trauma patients less than 18 years of age; poly trauma patients who had no abdominal injury; patients who expired with 10 minutes of presentation within emergency department or brought dead.
Results: A total of 150 trauma calls were generated during the year 2014. Out of these 150 trauma calls, 25 (16.6%) patients met the inclusion criteria of having intra-abdominal injury. Male to female ratio was 24:1. Among the patients who sustained abdominal injuries, 9 (26%) patients had blunt trauma to abdomen while 16 (64%) patients had penetrating abdominal injuries. In penetrating injuries, 15 (60%) cases were due to gunshot injuries while 1 (4%) was due to an assault. Sixteen (64%) patients required immediate laparotomy. Fifteen of these patients had penetrating injuries and 1 had blunt trauma, 8 patients were managed conservatively and 1 patient underwent angio-embolization of splenic artery. Time required to shift patient from ER to OT was variable between 36 minutes to 69 minutes with a mean value of 50 minutes. Patients who were managed conservatively had an ED stay time varying from 40 minutes to 160 minutes with mean value of 130 minutes. Of 25 patients who had abdominal injuries, 21 (84%) patients survived and 4 (16%) patients expired. Among the patients who went immediate surgical intervention, 3 patients expired and 1 patient who underwent angio-embolization of splenic artery expired.
Conclusion: Because of the concealed nature of intra-abdominal hemorrhage, one is likely to miss abdomen as a potential source of bleeding until patient decompensates to unresuscitable state of shock. Thus, appropriate management of severe trauma patients can only be achieved by a systematic evaluation by Trauma team according to ATLS guidelines. Our study concluded that the time factor for activation of trauma team and shifting of patient was not the major factor among patients who expired. Although the shifting time was fairly long for patients who were managed conservatively, it was not identified as a cause of death.
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