Nonoperative management of blunt trauma in abdominal solid organ: a prospective study to evaluate the success rate and predictive factors of failure

Over the past several years, nonoperative management (NOM) has increasingly been recommended for the care of selected blunt abdominal solid organ injuries. No prospective study has evaluated the rate of NOM of blunt abdominal trauma in the northwest of Iran. The objective of our study was to evaluate the success rate of this kind of management in patients who do not require emergency surgery.

This prospective study was performed in Imam Khomeini Hospital (as a referral center of trauma) at Tabriz University of Medical Sciences, Iran, between 20 March 2004 and 20 March 2007. All trauma patients who had sustained injury to a solid abdominal organ (kidney, liver, or spleen) were selected for initial analysis, using the student's t test or chi-square test.

During the 3 years of the study, 98 patients (83 male and 15 female) with blunt trauma were selected for NOM for renal, hepatic and splenic injuries. Mean age was 26.1 ± 17.7 years (range, 2–89) and the mean injury severity score (ISS) was 14.5 ± 7.4. The success rate of NOM was 93.8%. Fifty-one patients (43 men, eight women; mean ISS, 14.2 ± 5.8) underwent NOM of splenic trauma, 38 patients (33 men, five women; mean ISS, 12.9 ± 8.2) hepatic trauma, and nine patients (seven men, two women; mean ISS, 22.2 ± 7.6) renal trauma. Six patients underwent laparotomy due to the failure of NOM. The success rates of this treatment were 94.1%, 94.7% and 88.8% for the spleen, liver and kidney injuries, respectively. Female gender and ISS were significant predictors of the failure of NOM (P = 0.005 and P = 0.039, respectively).

We suggest that NOM can be undertaken successfully for the hemodynamically stable patients with solid organ blunt trauma. The study indicates that the rates of NOM vary in relation to the severity of the organ injury. These suggest that this approach to the care of blunt injury in abdominal solid organs is being led by trauma centers.