Risk factors of delayed diagnosis of pancreatic trauma

Objective: To identify risk factors associated with delayed diagnosis of pa ncreatic injuries. Design: Retrospective study. Setting: University hospital, Finland. Patients: 31 patients treated for pancreatic injuries from January 1986 to April 1998. Interventions: Clinical, laboratory, and radiological assessment Initial ma nagement operative (n = 22) and non-operative (n = 9). Main outcome measures: Timely or delayed (>12 hours after injury) recogniti on of pancreatic trauma. Results: Blunt trauma (7/17 timely and 12/14 delayed diagnosis, p = 0.03), intoxication on admission (4/10 compared with 5/5 patients studied, p < 0.0 5), low New Injury Severity Score (median, interquartile 34, 11.5-41 compar ed with 14.5, 10-25, p = 0.02), low Abdominal Trauma Index (38, 20-54 compa red with 16.5 15-24, p = 0.01), absence of associated abdominal organ injur ies (1/17 compared with 8/14, p = 0.004), and initial nonoperative manageme nt (2/17 compared with 7/14, p = 0.04) were significant risk factors of del ayed diagnosis of pancreatic trauma. The main reasons for the delay in diag nosis were missed pancreatic injury at initial operation (n = 4, 2 penetrat ing), failure to exclude blunt pancreatic injury before non-operative manag ement (n = 4), delay in presentation (n = 3), underestimation of the severi ty of pancreatic injury on initial computed tomogram (n = 2), and missed di agnosis of blunt duodenal rupture with mild pancreatic injury (n = 1). Conclusions: In patients with blunt abdominal trauma and altered consciousn ess with few clinical signs, and no or mild associated abdominal injuries, we recommend additional diagnostic studies to exclude pancreatic rupture be fore starting nonoperative management. Exposure and evaluation of the pancr eas during laparotomy for trauma is essential.