Relatively short diagnostic delays (< 8 hours) produce morbidity and mortality in blunt small bowel injury: An analysis of time to operative intervention in 198 patients from a multicenter experience

Objective: Blunt small bowel injury (SBI) is uncommon, and its timely diagn osis may be difficult. The impact of operative delays on morbidity and mort ality has been unclear. The purpose of this study was to determine the rela tionship of diagnostic delays to morbidity and mortality in blunt SBI. Methods: Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997), Patients with duodenal inju ries were excluded, Data were extracted by individual chart review. Patient s were classified as multi-trauma (group 1) or near-isolated SBI (group 2 w ith Abbreviated Injury Scale score < 2 for other body areas). Time to opera tion and its impact on mortality and morbidity was determined for each pati ent. Results: A total of 198 patients met inclusion criteria: 66.2% were male, m ean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score w as 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increa sed with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9. 1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%,p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and II hou rs IS minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. Conclusions: Delays in the diagnosis of SBI are directly responsible for al most half the deaths in this series. Even relatively brief delays las littl e as 8 hours) result in morbidity and mortality directly attributable to "m issed" SBI. Further investigation into the prompt diagnosis of this injury is needed.