Hollow visceral injury and blunt trauma
Allen, G.S.; Moore, F.A.; Cox, C.S.; Wilson, J.T.; Cohn, J.M.; Duke, J.H.
Journal of Trauma 45(1): 69-75; Discussion 75-8
1998
ISSN/ISBN: 0022-5282 PMID: 9680015 Document Number: 494665
Background: The incidence of hollow viscus injury (HVI) after blunt trauma (BT) is variable, and differences between children and adults have not been well described. The purpose of this study is to determine the age-group-related incidence and characteristics of BT-associated HVI as well as the clinical markers and consequences of delayed diagnosis. Methods: A 9-year trauma registry review of all patients with HVI. Results: A large sample of patients (19,621) with BT were evaluated (2,550 ltoreq 14 years old; 17,070 > 14 years old). One hundred thirty-nine of 17,070 (0.8%) adults had HVI compared with 27 of 2,550 (1%) children. HVI occurred more frequently in the duodenum in children (11 of 27) compared with adults (17 of 139) (p < 0.05). Among patients with abdominal wall ecchymosis, 13.5% of children had HVI compared with 10.6% of adults. Delays in diagnosis of HVI occurred in 9 of 27 children compared with 10 of 139 adults (p < 0.05). Delayed diagnosis was associated with increased abdominal septic complications in both children (4 of 9) and adults (2 of 10) compared with diagnosis at presentation (p < 0.05). Conclusion: HVI occurs with a similar low frequency in both children and adults. Duodenal injuries are more common in pediatric BT patients. Abdominal wall ecchymosis is associated with increased HVI but is less predictive of HVI than previously described. Contrary to previous reports, delays in diagnosis are associated with increased morbidity.