Nonoperative management of blunt abdominal trauma cases at a tertiary care center in India – An effective strategy

Background and Objectives: An emerging paradigm is observed toward the application of nonoperative management for blunt abdominal trauma (BAT) over invasive surgery. It is postulated that the nonoperative approach is more effective financially, is safe and has a higher success rate. To evaluate the success of the shift from an aggressive operative approach to nonoperative management in solid organ injuries due to BAT at a tertiary care center in North India. Materials and Methods: An observational study was undertaken to evaluate the management of 95 cases of BAT presenting to the emergency department at a tertiary care center in North India, over 12 months. Operative and nonoperative managements were recorded, and the outcome was assessed at 72 h. Categorical variables were analyzed using the Chi-square test; P < 0.05 was taken to indicate a significant difference. Results: Out of the 95 patients, 46% were between 20 and 40 years and 84% were males. The most common mechanism of trauma was road traffic accidents (67%), followed by falls. Specific organ injuries were found in 59% of cases; of these, 38% were injuries to the liver and 34% to the spleen. Overall, 21% of all the cases underwent operative management, whereas 79% were managed nonoperatively. Nonoperative management showed satisfactory outcomes in 89% of cases overall. Furthermore, 88.90% of solid organ injuries with computed tomography American Association for the Surgery of Trauma (CT-AAST) Grades of III or above were successfully managed with nonoperative management. Conclusions: Nonoperative management shows successful results while allowing us to avoid surgical stress, complications, and financial burdens along with an acceptable morbidity rate and low mortality rate. A high CT-AAST grade of injuries does not warrant surgery, and operative management should be used judiciously.