Role of Apache Iv and Serum Amylase Along With Urinary Amylase in Predicting Outcome of Blunt Trauma Abdomen – A Prospective Study

Abstract

Abstract Introduction- Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. The pre-existing anatomical scoring systems assess the extent of injury. We worked on evaluating the use of APACHEIV which is a physiological system and hence, determines the impact of injury, in predicting the outcome of blunt trauma abdomen. We also studied the role of serial serum and urinary amylase levels in predicting specific intra-abdominal organ injured. Though the role of biochemical markers is of meagre importance in a well- equipped tertiary care centre. But in countries like India, where a majority population still depends on primary and secondary health care which are equipped with very minimal infrastructure, these markers can play a small role in triaging patients and deciding further plan of action. Aims and objectives- To assess the role of serum and urinary amylase levels in predicting intra-abdominal organ injured. To assess the role of APACHE IV in predicting outcome of blunt trauma abdomen in terms of mortality and morbidity. Materials and Methods- This was a prospective study carried out in the Department of Surgery of M.L.N. Medical College, Prayagraj and associated Swaroop Rani Nehru Hospital. All patients above 16 years of age with Blunt trauma abdomen were part of the study. APACHE IV score at the time of hospital admission and serum and urinary amylase on day 1, 3 and 5 was calculated. Results- Significant correlation was seen between liver injury and urine amylase on day1 and 3; between spleen injury and urine amylase levels on day 3 and GIT injury and urine amylase on day 1 and day 5. Also, high APACHE IV score was associated with increased mortality and morbidity. Morbidity was determined particularly in terms of length of hospital stay, APACHE IV score of >44 was associated with hospital stay of more than 9 days.