Safety of early mobilization of patients with blunt solid organ injuries.

BACKGROUND: Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. OBJECTIVE: To determine whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries. DESIGN: Retrospective cohort study. Univariate and multivariate analyses were performed to determine the association of mobilization with delayed hemorrhage of a solid organ requiring laparotomy. SETTING: Level I trauma center. PATIENTS: Adults with blunt renal, hepatic, or splenic injuries were identified from a trauma registry. MAIN OUTCOME MEASURES: Medical records were used to determine the day of mobilization and to identify patients with delayed hemorrhage requiring laparotomy. RESULTS: Four hundred fifty-four patients with blunt solid organ injuries were admitted to the hospital for nonoperative management. Failure rates of nonoperative management were 4.0%, 1.0%, and 7.1% for renal, hepatic, and splenic injuries, respectively. No patients with renal or hepatic injuries failed secondary to delayed hemorrhage. Ten patients (5.5%) with splenic injuries failed secondary to delayed hemorrhage. Eighty-four percent of patients with renal injuries, 80% with hepatic injuries, and 77% with splenic injuries were mobilized within 72 hours of admission. Day of mobilization was not associated with delayed splenic rupture in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.90-1.05). CONCLUSIONS: The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.