Non-operative Management (NOM) of Blunt Abdominal Trauma (BAT): A Tertiary Care University Hospital Study

Author(s): Shashi Prakash Mishra, Sumit Sharma, Mumtaz A. Ansari and Vivek Srivastava

Background: NOM is considered a treatment option for all hemodynamically stable patients without peritoneal signs and many recent reports reveal success rates of 80%. In this study we evaluated the feasibility and safety of NOM of BAT in our hospital. Methods: This retrospective study comprises 86 patients with BAT who were admitted over a 3 year period. NOM was applied in 82.93% (34 patients) of all BATs with a failure rate of 17.07% (7 patients). Of these 7 patients of NOM failure were clubbed with OM group in order to perform statistical comparison. Finally comparison was done between NOM (n=64) and OM (n=22) group. The comparison was done between NOM and OM group in terms of demographic, medical history (co-morbidities), mode of injury, hemodynamic status, and organs injured, injury grading, length of hospital stay, morbidity and mortality. Results: Most of the patients were young adults (2045 years) with mean age being 32.45 years and age ranging between 16-62 years. The commonest cause of BAT (n=78, 90.69%) was Road traffic accident (RTA). No significant differences were observed between NOM and OM group in relation with age, sex, time of presentation (hours), co-morbidities and mechanism of injury. Injury severity score (ISS), hematocrit, hemodynamic status and blood transfusion were significantly different between NOM and operative group. NOM has a significant decrease in length of hospital stay, ICU admission and morbidity compared to patients who underwent surgery. NOM failure occurred in 4 patients with splenic injury and 1 patient with liver injury and 2 patients with hollow viscous perforation.6 patients were died in OM group. The success rate of NOM was 95.3%. Conclusion: NOM for BAT was found to be highly successful and safe. The patient with hemodynamically stable or easily stabilized trauma may be admitted to a non-ICU unit, with close monitoring of vital signs and regular clinical examinations.