Trends in the Nature and Management of Serious Abdominal Trauma
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.
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.
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).
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.
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.
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.
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