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Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen Study

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Abstract

Purpose

A selective nonoperative management (SNOM) of penetrating abdominal injuries (PAI) is a standard of care in numerous established trauma centers. However, available evidence supporting SNOM of PAI in European settings remains scarce. Thus, we performed a multi-center study at selected Northern European trauma centers to investigate the management and outcomes of PAI. We hypothesized that despite a low number of penetrating injuries in included trauma centers, SNOM is successfully utilized with outcomes comparable with trauma centers with a high number of PAI.

Methods

All adult patients admitted to participating trauma centers in the Northern European region with PAI between 1/2015 and 12/2016 were retrospectively reviewed. Primary outcomes were mortality and success rate of SNOM.

Results

Overall, 119 patients were included. Median age was 38 (28–47) years. SNOM was initiated in 55 patients (46.0%) with 94.5% success rate. Three patients (5.5%) failed SNOM and had a delayed laparotomy with one gastric injury, one small bowel injury and one patient with a bleeding from mesentery. Overall mortality of the cohort was 5.0%. However, all patients in the SNOM group survived. Higher median ISS, median Abbreviated Injury Scale score of the abdomen, rate of combined anterior and posterior wounds, rate of in-hospital complications and longer hospital length of stay were observed in the immediate laparotomy group compared to the SNOM group.

Conclusions

SNOM of PAI is a safe practice even in regions with a low prevalence of penetrating injuries. The outcomes in our study are comparable with results from trauma centers treating larger numbers of patients with PAI.

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Funding

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Authors and Affiliations

  1. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia

    Sten Saar, Arvo Reinsoo & Jaak Lepp

  2. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia

    Sten Saar, Arvo Reinsoo & Peep Talving

  3. Department of Traumatology, Oslo University Hospital, Oslo, Norway

    Joakim Jorgensen, Christine Gaarder & Pal A. Naess

  4. Faculty of Medicine, University of Oslo, Oslo, Norway

    Joakim Jorgensen, Aurora N. Lemma, Christine Gaarder & Pal A. Naess

  5. Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland

    Ari Leppäniemi & Ville Sallinen

  6. The University of Edinburgh, Edinburgh, Scotland

    Riinu Pius

  7. North Estonia Medical Centre, Tallinn, Estonia

    Peep Talving

Authors
  1. Sten Saar
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  2. Joakim Jorgensen
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  3. Aurora N. Lemma
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  4. Christine Gaarder
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  5. Pal A. Naess
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  6. Ari Leppäniemi
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  7. Ville Sallinen
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  8. Riinu Pius
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  9. Arvo Reinsoo
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  10. Jaak Lepp
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  11. Peep Talving
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Corresponding author

Correspondence to Sten Saar.

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Conflict of interest

S. Saar, J. Jorgensen, A.N. Lemma, C. Gaarder, P.A. Naess, A. Leppäniemi, V. Sallinen, R. Pius, A. Reinsoo1, J. Lepp and P. Talving declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Saar, S., Jorgensen, J., Lemma, A.N. et al. Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen Study. Eur J Trauma Emerg Surg 48, 2023–2027 (2022). https://doi.org/10.1007/s00068-021-01749-2

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  • DOI: https://doi.org/10.1007/s00068-021-01749-2

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