A comparison of management and outcomes following blunt versus penetrating pancreatic trauma: A secondary analysis from the Western Trauma Association Multicenter Trials Group on Pancreatic Injuries. Issue 5 (21st November 2022)

• Record Type: Journal Article
• Authors: Biffl, Walter L.; Ball, Chad G.; Moore, Ernest E.; West, Michaela; Russo, Rachel M.; Balogh, Zsolt; Kornblith, Lucy; Callcut, Rachael; Schaffer, Kathryn B.; Castelo, Matthew
• Other Names: Grimes Arthur D. author non-byline.; Lees Jason author non-byline.; Todd S. Rob author non-byline.; Pascual Jose author non-byline.; Weaver Jessica L. author non-byline.; Yanoff Matthew author non-byline.; Wydo Salina author non-byline.; Teichman Amanda author non-byline.; Privette Alicia R. author non-byline.; Leon Stuart author non-byline.; Morse Bryan author non-byline.; Koganti Deepika author non-byline.; McNutt Michelle K. author non-byline.; Puzio Thaddeus J. author non-byline.; Dultz Linda author non-byline.; Kulenschmidt Kali author non-byline.; Meagher Ashley author non-byline.; Douglas Anthony author non-byline.; Koenig Samantha M. author non-byline.; Bower Katie author non-byline.; Udekwu Pascal (Osi) author non-byline.; Roy Sara author non-byline.; Byerly Saskya author non-byline.; Rattan Rishi author non-byline.; Harrell Kevin N. author non-byline.; Maxwell Robert A. author non-byline.; Chen Allen author non-byline.; Davis James W. author non-byline.; Clements Thomas author non-byline.; Spalding Chance author non-byline.; Sperwer Kimberly author non-byline.; Flores Carmen author non-byline.; Chestovich Paul author non-byline.; Bala Miklosh author non-byline.; Kedar Asaf author non-byline.; Landis Ryan author non-byline.; Bishwajit Bhattacharya author non-byline.; Struve Isabella author non-byline.; Jurkovich Gregory J. author non-byline.; Burlew Clay author non-byline.; Gore Amy V. author non-byline.; Peck Kim author non-byline.; Rooney Alexandra S author non-byline.; Alam Hasan author non-byline.; Barmparas Galinos author non-byline.; Margulies Daniel author non-byline.; Cullinane Daniel author non-byline.; Cullinane Laura M. author non-byline.; Curran Barb author non-byline.; Nahmias Jeffry author non-byline.; Limney-Lasso Erika author non-byline.; Way Teagan L. author non-byline.; Schroeppel Thomas author non-byline.; Stillman Zachery author non-byline.; Zarzaur Ben author non-byline.; Cardenas Tatiana C.P. author non-byline.;
• Is Part Of: Journal of trauma and acute care surgery. Volume 93:Issue 5(2022)
• Page Start: 620
• Page End: 626
• Publication Date: 2022-11-21
• Subjects: Pancreas -- trauma -- pancreatectomy -- pancreatography -- morbidity; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003651
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : Outcomes after pancreatic trauma are directly related to the presence of main pancreatic duct injury. This study demonstrates that injury mechanism is an independent predictor of outcomes. Abstract : BACKGROUND: The impact of injury mechanism on outcomes of pancreatic trauma has not been well studied, and current guidelines do not differentiate recommendations for blunt and penetrating injuries. The purpose of this study was to analyze interventions and outcomes as they relate to mechanism. We hypothesized that penetrating pancreatic trauma results in greater morbidity than blunt trauma because of more frequent operative exploration without imaging and thus more aggressive surgical management. METHODS: Secondary analysis of a multicenter retrospective review of pancreatic injuries in patients 15 years and older from 2010 to 2018 was performed. Deaths within 24 hours of admission were excluded from analysis of the primary outcome, pancreas-related complications (PRCs). Data were analyzed by injury mechanism using various statistical tests where appropriate. RESULTS: Thirty-three centers reported on 1, 240 patients (44% penetrating). Penetrating trauma patients were twice as likely to undergo resection (45% vs. 23%) and suffer PRCs (39% vs. 20%). However, differences varied widely based on injury grade and management. There were fewer resections and more nonoperative management in blunt grades I to III injury. Pancreas-related complications occurred in 40% of high-grade injuries with no difference between mechanisms and in 40% of patients after resection, regardless of mechanism or injury grade. High-grade pancreatic injury (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.55–3.67), penetrating injury (OR, 1.99; 95% CI, 1.31–3.05), and management in a low-volume center (i.e., five or fewer cases/year) (OR, 1.65; 95% CI, 1.16–2.35) were independent predictors of PRCs. CONCLUSION: Management of grades I to III, but not grades IV/V, pancreatic injuries varies based on mechanism. Penetrating injury is an independent risk factor for PRCs, but main pancreatic duct injury and resection are associated with high rates of PRCs regardless of the injury mechanism. Resection appears to offer better outcomes for grade IV/V injuries, and grade I and II injuries should be managed nonoperatively. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. Abstract :