SOLID VISCUS INJURY PREDICTS MAJOR HOLLOW VISCUS INJURY IN BLUNT ABDOMINAL-TRAUMA

Background: As nonoperative management of blunt abdominal trauma has b ecome more popular, reliable models for predicting the likelihood of c oncomitant hollow viscus injury in the hemodynamically stable patient with a solid viscus injury are increasingly important. Methods: The Pe nnsylvania Trauma Systems Foundation registry was reviewed for the per iod from January 1992 to December 1995 for all adult (age > 12 years) patients with blunt trauma and an Abbreviated Injury Scale (AIS) score greater than or equal to 2 for a solid viscus (kidney, liver, pancrea s, spleen), Patients with an initial systolic blood pressure < 90 mm H g were excluded, Hollow viscus injuries included only lacerations or p erforations of the gallbladder, gastrointestinal tract, or urinary tra ct. Results: In the 4-year period, 3,089 patients sustained solid visc us injuries, 296 of whom had a hollow viscus injury (9.6%), The mean a ge was 35.6 years, mean Injury Severity Score was 22.2, and mean Revis ed Trauma Score was 7.3; 63.3% of the patients were male, A solitary s olid viscus injury occurred in 2,437 patients (79%), 177 of whom (7.3% ) had a hollow viscus injury, The frequency of hollow viscus injury in creased with the number of solid organs injured: 15.4% of patients wit h two solid viscus injuries (n = 547) and 34.4% of patients with three solid viscus injuries (n = 96) suffered a concomitant hollow viscus i njury (p < 0.001 vs, one organ), A hollow viscus injury was 2.3 times more likely for two solid viscus injuries and 6.7 times more likely fo r three solid viscus injuries compared with a solitary solid viscus in jury, For solitary solid viscus injury, the frequency of hollow viscus injury varied little with increasing AIS score (AIS score 2, 6.6%; AI S score 3, 8.2%; AIS score 4, 9.2%; AIS score 5, 6.2%) (p = 0.27 betwe en groups), suggesting that the incidence of hollow viscus injury is r elated more to the number of solid visceral injuries than the severity of individual organ injury, Also, when the sum of the AIS scores for solid viscus injuries was < 6, the mean rate of hollow viscus injury w as 7.8%, This increased to 22.8% when the sum of the AIS scores for so lid viscus injury was greater than or equal to 6 (p < 0.001), A pancre atic injury in combination with any other solid viscus injury had a ra te of hollow viscus injury of > 33%. Conclusion: A model of organ inju ry scaling predicted hollow viscus injury, Multiple solid viscus injur ies, particularly pancreatic, or abdominal solid viscus injuries with an AIS score greater than or equal to 6, were predictive of hollow vis cus injury, Identification of these injury patterns should prompt cons ideration for early operative intervention.