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World Journal of Surgery

, Volume 30, Issue 12, pp 2136–2141 | Cite as

A Population-Based Study of Pancreatic Trauma in Scotland

  • John M. ScollayEmail author
  • Vincent S.K. Yip
  • O. James Garden
  • R.W. Parks
Article

Abstract

Introduction

The aim of this population-based study was to assess the incidence, mechanisms, management and outcome of patients who sustained pancreatic trauma in Scotland over the period 1992–2002.

Methods

The Scottish Trauma Audit Group database was searched for details of any patient with pancreatic trauma.

Results

About 111 of 52,676 patients (0.21%) were identified as having sustained pancreatic trauma. The male-to-female ratio was 3:1, with a median age of 32 years. Blunt trauma accounted for 66% of injuries. Road traffic accidents were the most common mechanism of injury (44%), followed by assaults (35%). Thirty-four patients (31%) were haemodynamically unstable on arrival at hospital. Pancreatic trauma was associated with injuries to the chest (56%), head (30%) and extremities (30%); 73% of patients had other intra-abdominal injuries. Of those who left the emergency department alive, at least 77% required a laparotomy. The mortality rate (46%) was directly proportional to the number of injuries sustained (P < 0.05) and was higher in patients with increasing age (P < 0.05), haemodynamic instability (P < 0.05) and blunt trauma (P < 0.05).

Conclusions

Pancreatic trauma is rare in Scotland but is associated with significant mortality. Outcome was worse in patients with advanced age, haemodynamic instability, blunt trauma and multiple injuries.

Keywords

Injury Severity Score Blunt Trauma Road Traffic Accident Abbreviate Injury Scale Blunt Abdominal Trauma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The authors would like to acknowledge the assistance of Diana Beard and other members of the Scottish Trauma Audit Group who provided data and advice.

References

  1. 1.
    Nilsson E, Norrby S, Skullman S, et al. Pancreatic trauma in a defined population. Acta Chir Scand 1986;152:647–651PubMedGoogle Scholar
  2. 2.
    Akhrass R, Yaffe MB, Brandt CP, et al. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 1997;63:598–604PubMedGoogle Scholar
  3. 3.
    Craig MH, Talton DS, Hauser CJ, et al. Pancreatic injuries from blunt trauma. Am Surg 1995;61:125–128PubMedGoogle Scholar
  4. 4.
    Rickard MJ, Brohi K, Bautz PC. Pancreatic and duodenal injuries: keep it simple. ANZ J Surg 2005;75:581–586PubMedCrossRefGoogle Scholar
  5. 5.
    Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Arch Surg 1982;117:722–728PubMedGoogle Scholar
  6. 6.
    Henarejos A, Cohen DM, Moossa AR. Management of pancreatic trauma. Ann R Coll Surg Engl 1983;65:297–300PubMedGoogle Scholar
  7. 7.
    Olsen WR. The serum amylase in blunt abdominal trauma. J Trauma 1973;13:200–204PubMedGoogle Scholar
  8. 8.
    Bouwman DL, Weaver DW, Walt AJ. Serum amylase and its isoenzymes: a clarification of their implications in trauma. J Trauma 1984;24:573–578PubMedGoogle Scholar
  9. 9.
    Beckingham IJ, Krige JE. ABC of diseases of liver, pancreas, and biliary system: liver and pancreatic trauma. BMJ 2001;322:783–785PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson CD. Pancreatic trauma. Br J Surg 1995;82:1153–1154PubMedGoogle Scholar
  11. 11.
    Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg 1991;78:1196–1202PubMedGoogle Scholar
  12. 12.
    Beard D, Henry JM, Grant PT. National audit of the management of injured patients in 20 Scottish hospitals. Health Bull 2000;58:118–126Google Scholar
  13. 13.
    Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale 1990 Revision: Illinois, 1990Google Scholar
  14. 14.
    Champion HR, Sacco WJ, Copes WS, et al. A revision of the Trauma Score. J Trauma 1989;29:623–629PubMedGoogle Scholar
  15. 15.
    Kao LS, Bulger EM, Parks DL, et al. Predictors of morbidity after traumatic pancreatic injury. J Trauma 2003;55:898–905PubMedGoogle Scholar
  16. 16.
    Madiba TE, Mokoena TR. Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas. Br J Surg 1995;82:1236–1239PubMedGoogle Scholar
  17. 17.
    Degiannis E, Levy RD, Potokar T, et al. Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995;82:1240–1242PubMedGoogle Scholar
  18. 18.
    Bradley EL III, Young PR Jr, Chang MC, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg 1998;227:861–869PubMedCrossRefGoogle Scholar
  19. 19.
    Carr ND, Cairns SJ, Lees WR, et al. Late complications of pancreatic trauma. Br J Surg 1989;76:1244–1246PubMedGoogle Scholar
  20. 20.
    Leppaniemi A, Haapiainen R, Kiviluoto T, et al. Pancreatic trauma: acute and late manifestations. Br J Surg 1988;75:165–167PubMedGoogle Scholar
  21. 21.
    Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg 1990;125:1109–1113PubMedGoogle Scholar
  22. 22.
    Stone HH, Fabian TC, Satiani B, et al. Experiences in the management of pancreatic trauma. J Trauma 1981;21:257–262PubMedCrossRefGoogle Scholar
  23. 23.
    Jones RC. Management of pancreatic trauma. Am J Surg 1985;150:698–704PubMedCrossRefGoogle Scholar
  24. 24.
    Young PR Jr, Meredith JW, Baker CC, et al. Pancreatic injuries resulting from penetrating trauma: a multi-institution review. Am Surg 1998;64:838–844PubMedGoogle Scholar
  25. 25.
    Timberlake GA. Blunt pancreatic trauma: experience at a rural referral center. Am Surg 1997;63:282–286PubMedGoogle Scholar
  26. 26.
    Campbell R, Kennedy T. The management of pancreatic and pancreaticoduodenal injuries. Br J Surg 1980;67:845–850PubMedGoogle Scholar
  27. 27.
    Vasquez JC, Coimbra R, Hoyt DB, et al. Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center. Injury 2001;32:753–759PubMedCrossRefGoogle Scholar
  28. 28.
    American College of Surgeons: National Trauma Data Bank Report. Edited by Fildes JJ; 2005:20Google Scholar
  29. 29.
    Lin BC, Chen RJ, Fang JF, et al. Management of blunt major pancreatic injury. J Trauma 2004;56:774–778PubMedCrossRefGoogle Scholar
  30. 30.
    Scollay JM, Beard D, Smith R, et al. Eleven years of liver trauma: the Scottish experience. World J Surg 2005;29:744–749PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • John M. Scollay
    • 1
    Email author
  • Vincent S.K. Yip
    • 1
  • O. James Garden
    • 1
  • R.W. Parks
    • 1
  1. 1.Department of Clinical and Surgical Sciences (Surgery)University of EdinburghScotlandUK

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