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 intraperitoneal 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 nonoperative 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.