A STATEWIDE, POPULATION-BASED TIME-SERIES ANALYSIS OF THE INCREASING FREQUENCY OF NONOPERATIVE MANAGEMENT OF ABDOMINAL SOLID-ORGAN INJURY

Introduction Emergency operative intervention has been one of the corn erstones of the care of the injured patient. Over the past several yea rs, nonoperative management has increasingly been recommended for the care of selected blunt abdominal solid organ injuries. The purpose of this study was to utilize a large statewide, population-based data set to perform a time-series analysis of the practice of physicians carin g for blunt solid organ injury of the abdomen. The study was designed to assess the changing frequency and the outcomes of operative and non operative treatments for blunt hepatic and splenic injuries. Methods D ata were obtained from the state hospital discharge data base, which t racks information on all hospitalized patients from each of the 157 ho spitals in the state of North Carolina. All trauma patients who had su stained injury to a solid abdominal organ (kidney, liver, or spleen) w ere selected for initial analysis. Results During the 5 years of the s tudy, 210,256 trauma patients were admitted to the state's hospitals ( 42,051 +/- 7802 per year). The frequency of nonoperative interventions for hepatic and splenic injuries increased over the period studied. T he frequency of nonoperative management of hepatic injuries increased from 55% in 1988 to 79% in 1992 in patients with hepatic injuries and from 34% to 46% in patients with splenic injuries. The rate of nonoper ative management of hepatic injuries increased from 54% to 64% in nont rauma centers compared with an increase from 56% to 74% in trauma cent ers (p = 0.01). In patients with splenic injuries, the rate of nonoper ative management increased from 35% to 44% in nontrauma centers compar ed with an increase from 33% to 49% in trauma centers (p < 0.05). The rate of nonoperative management was associated with the organ injury s everity, ranging from 90% for minor injuries to 19%-40% for severe inj uries. Finally, in an attempt to compare blood use in operatively and nonoperatively treated patients, the total charges for blood were comp ared in the two groups. When compared, based on organ injury severity, the total blood used, as measured by charges, was lower for nonoperat ively treated patients. Conclusions This large, statewide, population- based time-series analysis shows that the management of blunt injury o f solid abdominal organs has changed over time. The incidence of nonop erative management for both hepatic and splenic injuries has increased . The study indicates that the rates oi nonoperative management vary i n relation to the severity of the organ injury. The rates of increase in nonoperative management were greater in trauma centers than in nont rauma centers. These findings are consistent with the hypothesis that this newer approach to the care of blunt injury of solid abdominal org ans is being led by the state's trauma centers.