Comparison between operative management versus non-operative management in patients with solid organ blunt abdominal injury in the National Trauma Registry of Iran.

Abstract

Background: Trauma is one of the leading causes of death worldwide. Severe abdominal injuries cause one-fifth of injury mortality. Non-operative management (NOM) or operative management (OM) is a primary challenge in abdominal injuries. In this study, we aimed to compare NOM and OM outcomes in patients with solid organ blunt abdominal injuries in the National Trauma Registry of Iran (NTRI).

Method: This cross-sectional study was conducted with data from the NTRI from 24 July 2016 to 21 May 2023. All patients with a solid organ abdominal injury by road traffic crash, falls, hit or bodily force, and assault with blunt objects were admitted to trauma registry member hospitals across the country, according to the NTRI criteria included in this study.

Results: Among 358 patients, liver, spleen, and kidney single-organ injuries were managed non-operative more than operative. Among multi-organ abdomen injuries, kidney injuries alongside spleen or liver injuries are managed non-operative more than operative. In the multiple regression model on the matched cohort (102 NOM with 102 OM), moderate or severe Glasgow Coma Scale (GCS) had 16.79 times more chance of Intensive Care Unit (ICU) admission than mild GCS [OR: 16.79, 95% CI (2.06, 137.22), P = 0.008]. Also, hypovolemia increased the chance of death 12.9 times [OR: 12.90, 95% CI (2.20, 75.53), P = 0.005]. In addition, for every 1-year increase in age, the odds of the death occurring increased 1.07 [OR: 1.07, 95% CI (1.02, 1.12), P = 0.005].

Conclusion: We observed the non-inferiority of NOM than OM due to the outcomes. Although the liver, spleen, and kidney are mainly managed by non-operatives.