A Prospective Study on Conservative Management of Solid Organ Injuries in Blunt Abdominal Trauma

Abstract

Introduction: Blunt abdominal trauma (BAT) is a leading cause of morbidity and mortality worldwide, with solid organ injuries traditionally managed operatively. Recent trends favor non-operative management (NOM) in hemodynamically stable patients. This study evaluates the feasibility, outcomes, and laboratory correlates of conservative management in solid organ injuries following BAT.

Aims & Objectives: To analyze the grades of solid organ injuries, study healing and recovery patterns, and evaluate outcomes of conservative management in BAT patients.

Materials & Methods: A prospective observational study was conducted at KD Medical College, Mathura from May 2024 to October 2025. Eighty-seven hemodynamically stable patients with blunt abdominal solid organ injuries (liver, spleen, kidney, pancreas, adrenal) were enrolled. All patients underwent detailed clinical assessment, CECT abdomen, and serial monitoring of hematological parameters. Conservative management included immobilization, vitals monitoring, and symptomatic treatment. Statistical analysis employed SPSS v26, with Friedman test for trends and Spearman's correlation.

Results: Mean age was 46.15±16.77 years with equal sex distribution. Liver (33.3%) was most injured, followed by kidney (25.3%). Grade I injuries predominated (42.5%). Assault (27.6%) and falls (26.4%) were commonest mechanisms. All patients were hemodynamically stable at admission. Serial hemoglobin, platelet, and lymphocyte percentages showed significant declining trends (p<0.001). Significant negative correlations existed between AAST grade and hemoglobin (r=-0.241 to -0.263) and platelet count (r=-0.289 to -0.312); positive correlation with lymphocyte percentage (r=0.234-0.277). Conservative management success rate was 100% (95% CI: 0.958-1.000), with no failures requiring surgery.

Conclusion: Conservative management of solid organ injuries in hemodynamically stable BAT patients is highly effective, with excellent success rates. Hematological parameters correlate significantly with injury severity and serve as useful monitoring tools.

REFERENCES

1. Peitzman AB, Heil B, Rivera L, Federle MB, Harbrecht BG, Clancy KD, et al. Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma. 2000;49(2):177-189. https://doi.org/10.1097/00005373-200008000-00002
2. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15(1):1-15.
3. Keric N, Shatz DV, Schellenberg M, De Moya M, Moore LJ, Brown CV, et al. Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2024;96(1):123-128. https://doi.org/10.1097/ta.0000000000004141
4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma. 1989;29(12):1664-1666. https://doi.org/10.1097/00005373-198912000-00013
5. Tan T, Luo Y, Hu J, Li F, Fu Y. Nonoperative management with angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2023;49(4):1751-1761. https://doi.org/10.1007/s00068-022-02054-2
6. Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J, et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 2009;67(6):1144-1149. https://doi.org/10.1097/ta.0b013e3181ba361f
7. Coccolini F, Montori G, Catena F, Di Saverio S, Biffl W, Moore EE, et al. Liver trauma: WSES position paper. World J Emerg Surg. 2015;10:1-10. https://doi.org/10.1186/s13017-015-0030-9
8. Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: evaluation, management and outcome. Clin Pract. 2014;4(2):1-4. https://doi.org/10.4081/cp.2014.599
9. Romano F, Iacobellis F, Guida F, Laccetti E, Sorbo A, Grassi R, et al. Traumatic injuries: mechanisms of lesions. In: Scaglione M, editor. Diagnostic Imaging in Polytrauma Patients. Cham: Springer International Publishing; 2017: 35-55. https://doi.org/10.1007/978-3-319-62054-1_2
10. Cheng TL, Fields CB, Brenner RA, Wright JL, Lomax T, Scheidt PC, et al. Sports injuries: an important cause of morbidity in urban youth. Pediatrics. 2000;105(3):1-8. https://doi.org/10.1542/peds.105.3.e32
11. Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207(5):646-655. https://doi.org/10.1016/j.jamcollsurg.2008.06.342
12. Patel P, Gadhavi J, Parmar H. A study of blunt and penetrating abdominal trauma, its various patterns of injuries, and its management. Int J Med Sci Public Health. 2016;5(7):1309-1312. https://doi.org/10.5455/ijmsph.2016.06082015193
13. Behera BK, Marsonia H, Bhatt J, Dave JP, Vagadia JG. A prospective study on non-operative management of solid organ injuries in blunt abdominal trauma patients. Asian J Res Surg. 2024;7(2):196-205.
14. Mukharjee S, BV D, SV B. Evaluation of management of CT scan proved solid organ injury in blunt injury abdomen—a prospective study. Eur J Trauma Emerg Surg. 2024;50(6):2753-2763. https://doi.org/10.1007/s00068-024-02501-2
15. Giannopoulos GA, Katsoulis IE, Tzanakis NE, Patsaouras PA, Digalakis MK. Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital? Scand J Trauma Resusc Emerg Med. 2009;17:1-6. https://doi.org/10.1186/1757-7241-17-22
16. Chowdhary SA, Kumar A, Malik AA, Bhasin SK. Outcome of conservative management of solid visceral injury in blunt trauma abdomen. JK Sci. 2024;26(3):165-169.
17. Nair IP. A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma. Int Surg J. 2020;7(6):1930-1934. https://doi.org/10.18203/2349-2902.isj20202061
18. Ibrahim W, Mousa G, Hirshon JM, El-Shinawi M, Mowafi H. Non-operative management of blunt abdominal solid organ trauma in adult patients. Afr J Emerg Med. 2020;10(3):123-126. https://doi.org/10.1016/j.afjem.2020.02.002
19. John S, Ravindrakumar C, Ramakrishnan R. Evaluation of the outcome of non-operative management in blunt abdominal solid organ injury. Int Surg J. 2016;3(2):626-632. https://doi.org/10.18203/2349-2902.isj20161134
20. Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12:1-26. https://doi.org/10.1186/s13017-016-0105-2