Penetrating abdominal trauma index as predictive factor affecting mortality and morbidity in penetrating abdominal trauma

Background: Trauma remains a big health problem in every country. Regardless of the level of socioeconomic development, trauma is responsible for 25% of the death in the USA. It is also the leading cause of death in the people from 1 to 44 years of age. Penetrating trauma is still the most frequent cause of death in the first four decades of life, and the rate of trauma causing morbidity and mortality increase in war time and violent conditions. In order to minimize the morbidity and mortality rate associated with penetrating trauma, the factors affecting morbidity and mortality were evaluated to choose those patients who need more intensive care and put them in the suitable ward with high facility or refer them to better centers. Study of these predictive factors also gives an idea about the efficacy of surgical team and hospital facilities and help in comparison between different trauma centers. Objectives: The aim of this study is to evaluate and analyze predictive factors for developing mortality and morbidity in penetrating abdominal trauma by using penetrating abdominal trauma index (PATI), number of intra abdominal organs injured, associated extra- abdominal injuries , age, sex, and type of injuring agent. Patients and methods: In this study 96 patients managed at Hospital for a period of 2 years. Patient age, sex, causative agent, severity of injury according to PATI and number of intra abdominal injured organ, associated extra- abdominal injuries and time between injury and arrival to hospital were studied. Results: Eighty Patients (83.3%) were males,16 (16.7%) were females. The male to females ratio was 5:1. The age of Patients were ranged from 1.5 to 60 years, with a mean age of 27.9 years ± SD 10.9 years, and the majority being in the third decade. Our study showed that the Injured intra-abdominal organs in decreasing frequency were large bowel (35.4%), liver (33.3%), small bowel (33.3%), diaphragm (22.9%), kidney (19.8%), stomach (19.8%), spleen (16.6%) and pancreas (7.3%). The extra- abdominal organ injured was chest (35.4%), upper limb (8.3%), lower limb (4.1%), head and neck (4.1%) and spinal cord (2.1 %). PATI was calculated in every operated Patient, the range of PATI was between (0 to 70) with a mean value (20.8 ± S.D 14). The study showed that PATI in dead Patients was the highest value while in morbid patients was more than 25, while patients with smooth post operative course was less than 25. Thirteen patients died (13.5%), 11 males (11.4%) and 2 females (2.1%) due to severe hemorrhage and consequences of dissaminating intravascular coagulation (DIC) and multiorgan failure (MOF). Seven (7.3%) of the dead Patients had extra- abdominal injuries. The morbidity rate was (37.5%) and the main cause of morbidity was wound sepsis (15.6%). Conclusion: Patients with penetrating abdominal trauma index more than 20 have greater possibility for developing complications and may need admition to intensive care unit (ICU) or respiratory care unit (RCU). Recommendation: 1. Efficient ambulance service, blood bank and regional trauma center are important to the reduction of the mortality and morbidity in trauma patients. 2. Increase the beds with good staff and equipments in ICU and RCU is important for decrease the mortality and morbidity in postoperative period. 3. Libral use of blood products is essential in management of penetrating abdominal trauma. 4. PATI is useful in planning management of patients with penetrating abdominal trauma.