Citation

Zimmerman WB, Baylor AE, Hall Zimmerman L, Dolman H, Ciullo JR, Dornbush J, Isaacson AR, Mansour R, Wilson RF, Tyburski JG. Cureus 2020; 12(1): e6826.

Affiliation

The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.

Copyright

(Copyright © 2020, Curēus)

DOI

10.7759/cureus.6826

PMID

32175202

PMCID

PMC7053694

Abstract

Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity.

METHODS This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a Level 1 Trauma Center over 30 years (1980-2010). Special attention was given to patients with concomitant genitourinary (GU) injuries.

RESULTS Of 1105 patients requiring an emergency laparotomy for trauma, 242 (22%) had urologic injuries including kidney 178 (16%), ureter 47 (4%), and bladder 46 (4%). Of the 242 patients, 50 (20%) died early (<48 hours) and 13 (5%) died later, primarily due to infection. A concept of "seven deadly signs" of hypoperfusion was developed. In patients with GU injuries, the presence of any deadly sign of hypoperfusion increased the mortality rate from 4% (6/152) to 63% (56/90), p<0.001. Of the 53 patients having a nephrectomy, 36 (68%) had one or more deadly signs and 27 (75%) died. Of 17 without deadly signs, only 2 (12%) died (p=0.001). Of 167 GU patients receiving blood, 59 (35%) developed infection vs 3/75(4%) in those receiving no blood (p<0.001).

CONCLUSIONS The presence of deadly signs of severe injury and hypoperfusion on admission was the major factor determining mortality. With a severely injured kidney plus any deadly signs of hypoperfusion, special efforts should be made to avoid a nephrectomy.

Copyright © 2020, Zimmerman et al.

Language: en

Keywords

acute care surgery; genitourinary; mortality; penetrating; trauma; urologic; urology