Non-operative management of blunt abdominal trauma: positive predictors

Abstract

Background: Over the last years a non-operative management (NOM) of blunt abdominal trauma has been included into the standard treatment guidelines in leading trauma centers all over the world. The success of NOM is based on careful patient selection. Nevertheless, the selection criteria have not been clearly determined up to now.Aim: To identify predictors of successful NOM and to create a diagnostic and treatment algorithm for its implementation.Materials and methods: 209 patients with abdominal trauma who underwent laparoscopy or NOM from January 2006 to September 2015 were included in the study. The hemoperitoneum volume and organ injury rate evaluated by using ultrasonography and computed tomography scan, as well as hemoglobin level, blood pressure, and peripheral pulse were analyzed. We performed comparative analysis of prognostic values of various selection criteria for NOM, such as: 1) Huang and McKenney ultrasound scoring systems for hemoperitoneum quantification; 2) hemodynamic parameters; 3) hemoglobin levels; 4) various combinations of the above mentioned factors; 5) Sonographic Scoring for Operating Room Triage in Trauma (SSORTT) scoring system.Results: Positive prognostic values of parameters included into the study varied from 88 to 91.7% when used separately or in combination with other scored factors. Furthermore, there was no significant difference between positive predictive value of all combinations of factors and McKenney ultrasound hemoperitoneum scoring system used alone.Conclusion: The proposed predictors as well as diagnostic and treatment algorithm are easy-to-use and available in clinical practice.

Keywords

• non-operative management
• abdominal trauma
• predictors