背景:伤害是世界范围内死亡的主要原因之一,腹部是头部和四肢后最常见的创伤区域。腹部损伤通常分为两类:钝性损伤和穿透性损伤。这项研究旨在确定在伊朗国家创伤登记处(NTRI)注册的患者中这两种类型的腹部损伤的流行病学和临床特征。
方法:这项多中心横断面研究是使用2016年7月24日至2023年5月21日NTRI的数据进行的。本研究纳入了国际疾病分类第10版(ICD-10)代码定义的所有腹部创伤患者。纳入标准是以下之一:住院时间(LOS)超过24小时,致命伤,和外伤患者从其他医院的ICU转移过来。
结果:在532例腹部损伤患者中,420(78.9%)钝伤,其中435人(81.7%)为男性。钝性创伤中最受伤的器官是脾脏,200(47.6%)和肝脏,171例(40.7%),分别。此外,结肠和小肠,42例(37.5%),穿透性损伤中受伤人数最多。在103例(23.5%)的钝性受伤受害者和17例(15.2%)的穿透性创伤中输血(p=0.03)。ICU入院在两组间有显著差异,钝器组266例(63.6%),穿透性47例(42%)(p<0.001)。穿透性损伤阴性开腹21例(28%),钝器组只有11例(7.7%)(p<0.001)。在调整后的多元逻辑回归模型中,与ISS1-8相比,ISS≥16的ICU入院机会增加了3.13倍[OR:3.13,95%CI(1.56至6.28),P=0.001]。另一个预测指标是NOM,比OM增加了1.75倍的ICU机会[OR:1.75,95%CI(1.17至2.61),p=0.006]。此外,GCS3-8的ICU入院几率是GCS13-15的5.43倍[OR:5.43,95CI(1.81至16.25),P=0.002]。
结论:这项研究发现,肝脏和脾脏在钝性损伤中大多受损。此外,在大多数穿透伤的情况下,与其他器官相比,结肠和小肠的损伤频率最高。腹部钝性损伤导致更多的输血和ICU入院。更高的国际空间站,较低的GCS,和NOM是腹部损伤患者入住ICU的预测因素。
BACKGROUND: Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and
penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI).
METHODS: This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals.
RESULTS: Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in
penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of
penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p < 0.001). Negative laparotomies were 21 (28%) in
penetrating trauma and only 11 (7.7%) in blunt group (p < 0.001). In the multiple logistic regression model after adjusting, ISS ≥ 16 increased the chance of ICU admission 3.13 times relative to the ISS 1-8 [OR: 3.13, 95% CI (1.56 to 6.28), P = 0.001]. Another predictor was NOM, which increased ICU chance 1.75 times more than OM [OR: 1.75, 95% CI (1.17 to 2.61), p = 0.006]. Additionally, GCS 3-8 had 5.43 times more ICU admission odds than the GCS 13-15 [OR:5.43, 95%CI (1.81 to 16.25), P = 0.002] respectively.
CONCLUSIONS: This study found that the liver and spleen are mostly damaged in blunt injuries. Also, in most cases of
penetrating injuries, the colon and small intestine had the highest frequency of injuries compared to other organs. Blunt abdominal injuries caused more blood transfusions and ICU admissions. Higher ISS, lower GCS, and NOM were predictors of ICU admission in abdominal injury victims.