SIGNIFICANCE OF ABDOMINAL INJURY FOR PROG NOSIS OF MULTIPLE TRAUMA CASES

Patients with multiple injuries were studied retrospectively (n = 483, ISS = 28 pts) and prospectively (n = 133, ISS = 42 pts) to determine the significance of concomitant intraabdominal lesions in the manageme nt and outcome of these subjects. In the retrospective part of the inv estigation 134 patients with intra-abdominal trauma presented with sig nificantly more severe injuries (ISS = 38) as compared to 349 subjects with bland abdomen (ISS = 25). This resulted in a significantly diffe rent mortality rate (27 vs 11 %). 119 patients with abdominal trauma w ere managed operatively, with surgery instituted within 4 hrs after th e accident in 104 cases. Delayed abdominal surgery was performed in 18 patients due to complications from the initial laparotomy and in 15 c ases because of delayed diagnosis. Delayed operations resulted in an i ncreased rate of local complications (33 vs. 6 % ). In the prospective part of the study 33 out of 133 patients succumbed during resuscitati on. In 14 of these, intractable bleeding from abdominal lesions was id entified as the cause. In the 100 primary survivors, there was found n o difference between 41 patients with and 59 patients without abdomina l pathology with respect to injury severity, mortality, complications, initial hemodynamic parameters or the secondary release of inflammato ry mediators. However, the initial requirement for red blood cell subs titution was significantly higher in subjects with intra-abdominal tra uma. Our results demonstrate that massive intra-abdominal hemorrhage m ay cause early mortality. In primary survivors, abdominal lesions have not shown to be of prognostic relevance, provided that early resuscit ation, early diagnosis and early operative therapy can be instituted.