Determinants of Successful Non-Operative Management of Intra- Peritoneal Bleeding Following Blunt Abdominal Trauma.

OBJECTIVES  To identify the  predictive factors of successful non-operative  management  of patients  with intraperitoneal bleeding following blunt abdominal trauma. METHODS This was cross-sectional study being performed in our Level I trauma center in southern  Iran between 2010 and 2011. We included adult (>14 years) patients with blunt  abdominal trauma  and intra-peritoneal hemorrhage  detected by CT-Scan who were hemodynamically stable and did not  require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative  management failure (NOM-F) while the other were non- operative management success (NOM-S). The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding. RESULTS Overall we included 80 eligible patients among whom there were 55 (68.7%) men and 25 (31.3%) women with mean  age of 30.63.6± years. Finally, 43 (53.8%) were successfully managed conservatively (NOM-S) while 37 (46.2%) required laparotomy (NOM-F). We found that those who underwent emergency laparotomy had significantly higher ĘHb (p=0.016) and lower base deficit (p=0.005) when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure (p<0.001) and higher shock index (p=0.002). The other parameters such as pulse rate and respiratory rate were comparable between two study groups. CONCLUSION In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative  management  are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission.