Ashika Rith, S (2023) A Prospective and Retrospective study on Factors Determining Operative and Non-Operative Management in Blunt Injury Abdomen. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: The main cause of trauma is Road Traffic Accident which alone accounts for more than 1 million deaths per year and liability of 20-50 million people. In 1982, the trimodal distribution of death has been described for injuries. In case of blunt injury abdomen, the third peak can be prevented with adequate ICU setup, proper and serial patient care. It is due to sepsis and multiple organ dysfunction. This management of blunt injury abdomen is a multimodality approach with early recognition, resuscitation and severity grading with analyzing the clinical status, radiological findings. These combined factors with the presence of ICU care with close monitoring/ tertiary setup may help us in conservative management in blunt injury abdomen in certain hemodynamically stable patients. AIM/ OBJECTIVE OF THE STUDY: The aim of this study is to analyse the various factors involved in and which determines the management in blunt trauma abdomen: 1.operative (surgeries) 2.non-operative (conservative, pigtail insertia, angioembolisation) Management. The various factors analysed are • Age of the patient. • Time of presentation. • Latent period between presentation and resuscitation. • Hemodynamic stability during the course of hospital. • Per abdominal examination findings. • eFAST/ CT severity grating-AAST grading. • Isolated injury or associated with other injuries. • ICU care with close monitoring. • Immobilization followed by restricted mobility. • Initiation of oral diet. METHODOLGY: STUDY DESIGN: Hospital based PROSPECTIVE AND RETROSPECTIVE OBSERVATIONAL STUDY with a sample size of 60. STUDY POPULATION: SINGLE CENTRE- RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL-Patients coming to Trauma ward with Blunt Trauma Abdomen. INCLUSION CRITERIA: • All the patients of age more than 14 years of both male and female sex presenting with blunt injury abdomen. • Patients associated with radiographical documentation of Liver, Spleen, Kidney, Pancreas, Hollow viscus (Bowel and Urinary Bladder). EXCLUSION CRITERIA: • Age less than 14 years. • Penetrating trauma to abdomen. • Patients with major head injury and polytrauma. RESULTS: ➢ In the current study, patients with blunt injury abdomen, most of them were males accounting to 88%. The average age of the participants was 32.62 years, with the vast majority (68%) falling within the age range of 21 to 40. ➢ The commonest mode of injury in our study was RTA (76.7%). ➢ In our study, 33% had Liver injury, 32% had Splenic injury. In the liver injury, 75.07% were managed conservatively and 24.9% non-conservatively. Amongst the Splenic injury, 65.2% were managed non operatively and 34.71% were managed by operative procedures. With positive clinical findings, 6.7% in the current study had grade III splenic injury, 3.3% with grade II liver injury, 3.3% with grade IV liver injury. ➢ When the latent period between presentation after injury and resuscitation is less, more patients are going into conservative management as within 1-5 hours, 71.4% of the patients went into conservative management as compared with 28.5% of the patients who were operated. When the patients were presented after 56 hours nearly 75% of the patients were operated as compared with 25% of the patients who were managed conservatively. ➢ Positive clinical per abdomen findings plays an important role in deciding the line of management. ➢ eFAST was positive in 68% while it was negative in 31%. Out of 60 patients, 13% were managed conservatively and 21% non conservatively. i.e., 38% conservatively and 61.7% by operative methods in eFAST positive patients. ➢ 53% of the individuals were admitted in ICU while 46% were managed in ward who required operative management. 41.17% were admitted in ICU whereas 58.8% were not. ICU admission helps in early identification of operative management. ➢ In conservative management the mean days of immobilization are 8-14 days in which 26% of them were managed. In operative line of management, the mean days of immobilization are 0-7 days in which 18% of them were managed. In conservative management the death is after 15 days and that is after immobilization.i.e., 2%. ➢ 48% of the study respondents were managed conservatively, 5% needed icd insertion for pneumothorax, emergency laparotomy with splenectomy was done in 5%, bladder repair in 1.7%, nephrectomy in 1.7%, emergency laparotomy with packing was done in 3.3%. in total 56.7% were managed with non-operative management and 43.3% were operated. ➢ There is significant mean difference between operative and non-operative procedure when compared with latent period, pulse rate, immobilisation days which is statistically significant with p-value<0.05. The mean pulse rate in conservative management is 96/min, whereas it is 131/min in operative management. CONCLUSION: In Blunt Trauma Abdomen, there is significant relation between the latent period and line of management, initial resuscitation with fluids and blood with close monitoring is crucial to decrease the operative management in solid organ injuries. There is significant relation between tachycardia, hemodynamic instability and operative management. When there is massive hemoperitoneum with hemodynamic instability or activation of massive blood transfusion protocol, then emergency surgical intervention should be considered. Hollow viscus perforation needs prompt and early surgical intervention. Delay in its management increases the morbidity and mortality. Positive per abdominal findings with bedside eFAST in addition to ICU care with close monitoring has a significant role in early decision for surgery.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100505 |
| Uncontrolled Keywords: | Factors Determining Operative, Non Operative Management, Blunt Injury Abdomen. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 06:00 |
| Last Modified: | 19 Jan 2024 16:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21295 |
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