The patterns of abdominal trauma and factors associated with ICU admission in a major trauma center in Medina

Amal Muflih Alqarafi, Asmaa Mesad Alhazmi, Areej Mustafa Alawfi, Emtinan Mohammed salem Alruhaili, Ftoon Abdualrahman Alebrahaimi, Sami Hussain Sebeih

Abstract

Background
Trauma is a significant health problem in Saudi Arabia. In polytrauma victims, the abdomen is the second most affected body region following the head. In the Middle East, abdominal trauma prevalence ranges from 15 per cent to 82 per cent.

Aims
This study aims to assess the patterns of blunt and penetrating abdominal traumas and to assess the factors associated with ICU admission.

Methods
This is a retrospective analytical study conducted at a major trauma centre in Medina, Saudi Arabia. Admitted abdominal trauma patients from 2015 to 2018 were included. Paediatric and isolated extra-abdominal traumas were excluded. Descriptive analysis was used to identify patterns of abdominal trauma. Chi-squared test and independent t-test were applied to evaluate the association of the mechanism of injury, solid abdominal organs, associated extra-abdominal injuries, and type of injury. Multiple regression analysis was conducted to assess factors associated with ICU admission in abdominal trauma.

Results
We included a total of 218 patients with a mean age of 32.7±13.9 years. Males (78.4 per cent) were predominantly greater in number than females (21.6 per cent). The primary mechanisms of injury were motor vehicle collisions (MVCs) (76.6 per cent), followed by stab wounds (12.4 per cent) and falls (7 per cent). The liver and spleen were the most injured organs (31 per cent and 30 per cent, respectively). Chest injuries were the most associated extra-abdominal trauma (47.2 per cent). The majority of MVC patients (88.6 per cent) had BTA, while stab wound was the main mechanism of injury in penetrating trauma (12 per cent) (P < 0.001). Penetrating trauma patients required laparotomy more than BTA patients (52.9 per cent and 8 per cent; P < 0.05). Eighteen percent of patients needed ICU admission. Factors positively associated with ICU admission (P < 0.05) were head and neck, musculoskeletal, and thoracic injuries and a moderate Revised Trauma Score (RTS).

Conclusion
Blunt abdominal trauma was the dominant type of abdominal injury in this study. The majority of patients were young adult males. MVCs and stab wounds were the predominant mechanisms of injury. The most affected organs were the liver and spleen. Chest injuries were the most associated extra-abdominal trauma. Factors positively associated with ICU admission were head and neck, chest, and musculoskeletal injuries and a moderate RTS.
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