Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm.

ABSTRACT

PURPOSE: The relevance of pancreatic trauma in severely injured patients within a large collective has not been thoroughly analyzed yet. This study aimed at assessing the prevalence of pancreatic trauma in relation to the outcome and the currently established algorithm of treatment. METHODS: Some 51,425 patients from the Trauma Register of the German Society of Trauma Surgery (TR DGU) (1993-2009) were retrospectively analyzed. All patients with an "injury severity score" ≥16, direct admission to a trauma center and subsequent treatment for at least 3 days, age ≥16, and an abdominal injury [abbreviated injury scale (AIS)(abdomen) ≥2] were included. Patients with abdominal trauma (AIS(abdomen) ≥2) were compared with patients with an additional pancreatic trauma (AIS(pancreas) 2-5). RESULTS: Of 51,425 patients, 9,268 (18%) had documented abdominal injuries. Two hundred eighty-four (3.1%) patients with abdominal injury additionally showed a pancreatic injury (AIS(abdomen) ≥2, AIS(pancreas) 2-5) and were analyzed in dependency of the classification of the American Association for the Surgery of Trauma (AAST) organ severity score. AAST-pancreas II°, 1.9%; III°, 0.6%; IV°, 0.3%; and V°, 0.2%. Patients with leading pancreatic injury (grades IV and V) thereby showed a significant increase of mortality (IV°, 30.0% and V°, 33.3%) and an increase of the need for surgical intervention (IV°, 80.6% and V° 81.8%). CONCLUSIONS: The results presented here show the prevalence and the outcome of pancreas injury in a large collective within the TR DGU for the first time. Based on the current literature and the findings, a treatment algorithm has been developed.