A prospective observational study of outcome of conservative management in blunt abdominal trauma

Abstract

Introduction: Blunt abdominal trauma (BAT) presently is the third most common form of trauma worldwide. The management of blunt abdominal trauma (BAT) is challenging. Management may involve non-operative measures or surgical treatment, as appropriate. Recently there has been increasing trend towards non operative management (NOM) of blunt trauma amounting to 80% of the cases with failure rates of 2-3%. NOM is a standard protocol for hemodynamically stable solid organ injuries. Present research was conducted to study the spectrum, mode of injuries and role of conservative management and its subsequent outcome in cases of BAT. Material & Methods: A hospital based prospective observational comparative study was conducted at Department of Surgery of a tertiary care hospital. A total of 50 cases of blunt abdominal trauma coming to our hospital and fulfilling eligibility criteria were included in the study after taking informed consent. After initial assessment and stabilization of the patient in the emergency ward, the patient was followed in the inpatient ward to assess for clinical improvement. Management decisions i.e. conservative or operative was taken by treating surgeons. All cases managed conservatively were monitored closely for any complications and requirement for conversion to operative treatment was noted. Data was analyzed using statistical software SPSS ver. 21.Results: Mean age of the study subjects was 32.62 years with 94% males. Most common mode of Injury was road traffic accident (80%) followed by fall from height (20%). Most common site of injury in blunt abdominal trauma cases was spleen (34%) followed by liver (26%). Conservative management was tried initially in 47 (94%) cases. A total of 7 patients out of 47 (14.9%) were converted from conservative to operative management after initial investigations. During the course of hospital stay, 4 out of 40 (10%) cases were converted to operative management. Mortality rate observed in the cases of abdominal blunt trauma in present study was 16%. A solitary patient expired on conservative management, giving failure rate in conservatively managed cases as 2.8%.Conclusion:Our study proves that non operative management is a safe and effective method in the treatment of blunt injury abdomen. Close monitoring of vital signs and repeated clinical examinations is important as management by conservative management depends on clinical and hemodynamic stability of the patient.