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Trends in the Nature and Management of Serious Abdominal Trauma

  • Noha FerrahEmail author
  • Peter Cameron
  • Belinda Gabbe
  • Mark Fitzgerald
  • Kate Martin
  • Ben Beck
Original Scientific Report

Abstract

Background

There have been recommendations for increased non-operative management (NOM) of abdominal trauma in adults. To assess the impact of this trend and changes in the epidemiology of trauma, we examined the management of serious abdominal injuries and mortality, in Victorian major trauma patients 16 years or older, between 2007 and 2016.

Methods

Using data from the population-based Victorian Trauma Registry, characteristics of patients who underwent laparotomy, embolisation, laparotomy and embolisation, or NOM, were compared with the Chi-square test. Poisson regression was used to determine whether the incidence of serious abdominal injury changed over time. Temporal trends in the management of abdominal injury and in-hospital mortality were analysed using, respectively, the Chi-square test for trend, and multivariable logistic regression.

Results

Of 2385 patients with serious abdominal injuries, 69% (n = 1649) had an intervention; predominantly a laparotomy (n = 1166). The proportion undergoing laparotomy decreased from 60% in 2007 to 44% in 2016 (p < 0.001), whilst embolisation increased from 6 to 20% (p < 0.001). Population-adjusted incidence of abdominal injury increased 1.6% per year (IRR 1.016, 95% CI 1.002–1.031; p < 0.024), predominantly in people aged 65 years and over (4.6% per year). Adjusted odds of in-hospital mortality declined 6.0% per year (adjusted odds ratio 0.94; 95% CI 0.89, 1.00; p = 0.04).

Conclusions

Whilst the incidence of major abdominal trauma increased during the study period, there was a reduction in the proportion of patients managed with laparotomy and reduction in the adjusted odds of in-hospital mortality. Older patients, for whom management is influenced by the complex interplay of frailty and co-morbidities, had lower laparotomy rates.

Notes

Acknowledgements

The Victorian State Trauma Registry is a Department of Health and Human Services, and Transport Accident Commission funded project. The Victorian State Trauma Outcome Registry and Monitoring group is thanked for the provision of VSTR data. The authors thank Sue McLellan for her assistance with the data.

Funding

The Victorian State Trauma Registry (VSTR) is a Department of Health, State Government of Victoria and Transport Accident Commission funded project. Ben Beck was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). Peter Cameron was supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship (#545926). Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048).

Compliance with Ethical Standards

Conflict of interest

There are no financial or other relationships that may lead to a conflict of interest or influence the content of the manuscript.

Supplementary material

268_2018_4899_MOESM1_ESM.docx (111 kb)
Supplementary material 1 (DOCX 111 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityPrahranAustralia
  2. 2.Trauma ServiceThe Alfred HospitalMelbourneAustralia

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