Factors of morbidity in solid organ injury

IntroductionToday, non-operative management of solid organ injuries secondary to an abdominal trauma has come to a level that each general surgeon can perform in any average hospital. Thus, number of redundant surgeries of solid organ injuries after an abdominal trauma, is decreased by the leading role of the trauma centers and the trauma surgeons, and by general surgeons espousing non-operative management. Today, in each hospital where patients can be monitorized closely and adequate medical equipment is present, even high grade injuries can be treated by non-operative management.In this study, we aimed to explore the effects of dermographic characteristics, biochemical parameters, transfusion amounts and trauma scores of the patients with solid organ injuries after trauma, on morbidity.Patients and MethodWe analyzied retrospectively 109 patients with a diagnosis of solid organ injuries due to abdominal trauma between october 2005 and October 2010 in the department of general surgeon of the dicle universty faculty of medicine.The results of the patients age,gender,interval time of the trauma,vital status (pulse, arterial tension,respiratory rate ), hematocrite levels, ALT and AST levels, the presence of free fluid in the abdominal in ultrasonography,the mechanism of trauma, injuries of the extra-abdominal system, number of solid organ injuries, the degree of injury in abdominal CT, the number of the blood transfusions, the length of the hospital stays, the operation times of the patients, scors of trauma (ISS,RTS,scala of Glaskow,TRISS ), causes of morbidity and mortality were compared.Follow-up period after trauma,embolism,infection,hematoma of the intraabdominal, infection of the catather, deep vein trombosis viewed as a factors for the morbidity.ResultsOf the remaining 109 patients, were followed and treated because of the isoleted solid organ injury after abdominal trauma, 81 were male and 28 were female.Mean avarage age was 37,6±18.28 (15-78). That the mechanism of abdominal trauma patients were examined; 58 were traffic accidents, 27 were fall from height, 14 were assault, 5 were stab wounds, 5 were gunshouts. Ranked 69 of liver injury with CT scan in 14 grade 1, 32 were grade 2, 22 were grade 3, 1 was grade 4 injury. Again ranked 63 of spleen injury with CT scan in 21 grade 1, 27 were grade 2, 11 were grade 3, 4 were grade 4 injury. Follow-up surgical procedure was performed on the first day 9 of 109 patients were treated conservatively. The indication of surgery in these patients is hemodynamic instability despite the treatments.The average 0.81 units of blood were transfused the patients received medical treatment. The average was 2.66 units of blood trasfusion 9 patients with hemodynamic instability after medical treatment. While morbidity of the 22 patients mean 1.54 units of blood transfusion, 0,42 units of blood were transfused 78 patients without morbidity. The mean average length of hospital stay 6.46 days after travma the patients received medical treatment. While morbidity of the 22 patients mean time 8.13 day, the average day was 5.98. 78 patients without morbidity. 22 of all palients were followed medical after trauma, morbidity was observed.In our study, unless hemodynamic instability and peritoneal irritation,non-operative treatment appears to be safe to solid organ injury after trauma. Because with liver and spleen injuries, the number of respiratory rate, trauma scores, elevation of ALT and AST is emphasized as factor for morbidity.ConclusionMedical follow-up, patients with solid organ injury after trauma, not only for low-risk patients but can also be applied to high-risk patients. With liver and spleen injuries, the number of respiratory rate, trauma scores, elevation of ALT and AST is determineted effect on morbidity.