Diagnostic, therapeutic and health-care management protocol for major abdominal trauma at the “Santa Maria” Hospital of Terni.

Abstract

BACKGROUND: Trauma is the fourth leading cause of death and is more common in people under 45 age. Abdominal trauma is cause of death in 7-10% of traumatized patients. Aim is to evaluate the effectiveness of the diagnostic, therapeutic and health-care management protocol for major abdominal trauma.

METHODS: A prospective study called DGR Azienda Ospedaliera S. Maria Terni n. 159. was registered on February 2014. Patients with abdominal major trauma admitted at Santa Maria Hospital of Terni from January 2015 to December 2016 were considered in this paper. Patients’ demographics, comorbidities, application of the operative and non operative management (OM-NOM), Mortality, effectiveness of diagnostics were investigated.

RESULTS: The most of the patients were the elderly. Staff members were compliant and operated in conformity to the protocol for abdominal trauma. Non operative management (NOM) was performed in 63% of patients, according to data from the literature. On the other hand data with respect to the performing of diagnostic examinations as Focused assessment with ultrasonography for trauma (FAST), chest X-ray, Computed Tomography (CT) were discordant with literature. No patient underwent damage control surgery (DCS). Number of missed injuries (3.3%) and overall (13.3%), daily and weekend mortality were similar to those from the available literature. In our experience, the best results were found regarding the sensitivity of the FAST and CT in unstable and stable patients respectively, and the lower incidence of: NOM failure (NOM 0%, NOM plus endovascular treatment 14.4%) , mortality in stable patients (2.3%) and night mortality (5%).

CONCLUSIONS: Despite the application of trauma protocol at Terni Hospital has been effective it can be further improved.