Description

Velmahos et al identified factors affecting the success and failure of nonoperative management of a patient after blunt abdominal trauma. This can identify patients who may benefit from more aggressive management or closer monitoring. The authors are from the University of Southern California in Los Angeles.

Parameters:

(1) nonliver injury (usually injury to spleen, kidney)

(2) FAST results (focused abdominal sonography for trauma)

(3) need for blood transfusion

(4) amount of intra-abdominal fluid on CT scan

 Parameter Finding Points nonliver injury absent 0 present 1 FAST results negative 0 positive 1 need for blood transfusion no 0 yes 1 intra-abdominal fluid <= 300 mL 0 > 300 mL 1

X =

= (1.5620 * (points for nonliver injury)) + (1.2138 * (points for FAST)) + (2.568 * (points for blood transfusion)) + (1.6996 * (points for intra-abdominal fluid)) - 3.8622

odds of failure for nonoperative management =

= EXP(X)

probability of failure =

= 1 / (1 + (1 / (odds)))

where:

• The conversion of odds to probabilities is discussed in Chapter 39.

• The data in Table 3 shows "liver injury" while the equation uses "nonliver injury". To get the values shown in Table 3 from the equation, a "yes" for "liver injury" has to be entered as a "no" in the equation. It appears as if "liver injury" refers to liver injury only (no non-liver injury).

• In Table 4 (page 848) they show that no patients with blunt trauma limited to the liver failed nonoperative management. If the spleen only was injured, the failure was around 54%. If the kidney only was injured, the failure was 18%.