Delay in Diagnosis of Hollow Viscus Injuries: Effect on Outcome

Abstract

Delay in the recognition of hollow viscus injury may lead to increased morbidity and mortality. Unfortunately the early diagnosis of these injuries remains a diagnostic challenge increasing the likelihood of delay. Patients transferred to Level I trauma centers from outlying institutions may be at increased risk of morbidity from hollow viscus injury, as there is an inherent delay associated with transfer. Herein we reviewed our institution's 11-year experience with the diagnosis and treatment of hollow viscus injury caused by blunt mechanism. Forty-one patients met defined criteria of hollow viscus injury. Patients were stratified into two groups: interval to operating room ≤24 hours versus >24 hours. Length of hospital stay, number of ventilator days, and percentage of patients developing acute respiratory distress syndrome were significantly greater in the >24-hour group. Mortality was not significantly different between the groups (26.7% vs 36.4%). Patients transferred from other institutions were more likely to experience complications and operative delay. In conclusion delay in operative intervention (>24 hours) adversely affected outcomes. Early transfer of patients to Level I trauma centers may improve outcomes. A high index of suspicion and the use of multiple diagnostic modalities may lead to earlier operative treatment and improved outcome.