Trauma is the most common cause of mortality among the age group 1-45 years and causes loss of productive days more than other notorious diseases such as cardiovascular diseases and malignancies. Regardless of the socioeconomic status, it remains a major public health problem among all countries [1,2].

Abdominal trauma is a very common presentation in emergency department patients. Road traffic accidents, Warfare injuries, fall from Heights, Sports accidents, Martial arts, Athletics, Mountaineering etc. are main causes of blunt trauma abdomen [3].

In civilian life, the majority of abdominal injuries are due to blunt trauma secondary to high‑speed automobile accidents. Penetrating injuries, although often associated with wartime combat, are seen with increasing frequency in hospital emergency departments, particularly in urban areas [4].

Blunt Trauma Abdomen (BTA) is one of the major causes of mortality and morbidity in trauma care centers. In order to reduce mortality in blunt trauma abdominal cases, risk factors for mortality need to be systematically identified and studied. In recent years, studies have identified several such risk factors, including age, gender, mode, pattern of BTA. There is contrasting reports of incidence, pattern and outcome of BTA [2,3].

No study has been there from our institute regarding the socio-demographic factors and prevailing pattern of Blunt Trauma Abdomen injury. So, we conduct this study to determine the Socio-Demographic and Etiologic Profile of Blunt Trauma Abdomen patients in a tertiary care Hospital.

Aims and objective

To determine the Socio-Demographic and Etiologic Profile of Blunt Trauma Abdomen patients in a tertiary care Hospital.

Study Design

Observational prospective study.

Study Period

July 2018 to December2019.

Study Population

FAST positive patients admitted in study period at ATC PGIMER Chandigarh, India were included in the study as per the inclusion and exclusion criteria. Informed understood written consent was taken from all the patients and approval from the institute’s ethical committee was obtained.

Sample Size

Seventy-five consecutive patients were recruited based on satisfying the inclusion and exclusion criteria. All the recruited patient's injuries were classified according to existing classification of organ injury. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored.

Eligibility

All consecutive patients with blunt trauma abdomen admitted during the time Frame of the study.

Inclusion Criteria

• All patients with blunt trauma abdomen having FAST POSITIVE or evidence of solid or

• Viscous injury clinically or radiologically

• Both Sex

• Age >14 years and <80 years

• Patients giving a valid informed consent

Exclusion Criteria

Age <14 years as they are managed by department of pediatric surgery at PGIMER Chandigarh

• Patients who refuse to give consent.

• Patients having GCS score less than or equal to 4 on arrival

Advance Trauma Center PGIMER Chandigarh is the major trauma center of India and it caters major population of Punjab, Haryana, Chandigarh, Himachal, Uttar Pradesh, Bihar, J&K, Rajasthan and act as referral center for the urban and rural hospitals within the region. It has a computerized registry into which trained data collectors have prospectively entered data on all injury admissions. Patients admitted for Blunt Trauma Abdomen were taken into study and categorized into:

• Patients with hollow viscous perforation

• Patients with solid organ injury

• Patients with solid and hollow viscous organ injury along with other coexisting injuries

Patients were managed as per existing protocol of trauma guidelines of the institute and ATLS guidelines and outcome in term of morbidity mortality and length of hospital stay was monitored. Operative, non-operative management and its indications and outcomes were evaluated.

Clinical Course

Patients with blunt trauma abdomen were taken and their history was taken. Name, age, sex, residence, mode of injury, time of injury, time of arrival at ATC, brief history about antecedent incident was taken. Primary survey was done and GCS of patient and vitals such as pulse, blood pressure, respiration was noted. Airway, breathing, circulation was secured as per ATLS guidelines. Secondary survey was done, and detailed injuries were noted from head to toe.

After initial resuscitation patient underwent routine blood investigations such ABG, haemogram, blood biochemistry including electrolytes, renal function test and liver function test. Medico legal x-rays of skull with cervical spine, bilateral hip with pelvis, chest and abdominal X-ray was performed in addition injury specific x rays. FAST was done preliminary for BTA. In FAST positive patients CECT abdomen was performed and details of organ injured was noted. All the injuries noted clinically and by radiology were given an AIS and ISS score. Specific organ injuries were graded according to AAST grading of organ injuries.

Conservative or surgical management was done as per existing guidelines of institute. Conservative management includes BTA charting (hourly monitoring of pulse, blood pressure, respiration rate, urine output, abdominal girth, febrile status, 6hourly hemogram) transfusion of blood products, radiological interventions like percutaneous drainage or angioembolization, as guided by the clinical status of the patient, biochemical and radiological findings.

Surgical management for hollow viscus perforation and hemodynamicaly unstable solid organ injury includes exploratory laprotomy. Postoperatively, patient was monitored and managed according to clinical features, hemodynamic status with the help of biochemical and radiological investigations as indicated. Mortality and morbidity were noted.

Statistical Analysis

Data were summarized and expressed as frequency and percentages. All calculations were conducted with standard statistical programs (SPSS 8.01, SPSS, Inc, and Chicago IL).

Observations and Results

Seventy-five patients admitted to Trauma center during study period were selected for the study based on inclusion and exclusion criteria. Following observations were made based  on  their  admission  and  their  stay  and management. There were 75 patients who were included in this study belonged to the age group 16-75 years. The most common age group affected was 16-30 years which constitute 56% of total affected population. 61-75 years group constituted least affected group (Table 1 and Figure 1).

Ninety two percent (n=69) of affected population were males whereas 8% (n=6) were females (Table 1 and Figure 2). Road side accident constitutes most common mode of injury 59 (78.66%) of cases followed by fall from height 11(14.67%). (Table 2 and Figure 3). Fifty two percent of blunt trauma abdomen cases were high velocity accidents (Table 2 and Figure 3).

Table 1: Age Distribution in Blunt Trauma Abdomen Patients

Table 2: Modes and Mechanism of Injury

Figure 1: Age Distribution in Blunt Trauma Abdomen Patients

Figure 2: Gender Distribution in Blunt Trauma Abdomen

In our, 7 patients (9.3%) had isolated injuries; while remaining 68 patients (91.7%) had associated injuries to other systems. Chest injuries were present in 33 patients (44%) followed by musculoskeletal injuries in 25 patients (33%), and pelvis injuries in 10 patients (13.3%) (Table 3).

Table 3: Associated Injuries with Blunt Trauma Abdomen

Table 4: Comparison of Organs Involved in Blunt Trauma Injury

Table 5: Comparison in Isolated and Multi-Organ Involvement

Figure 3: Modes of Injury

Figure 5: Comparison in Isolated and Multi-Organ Involvement

In the present study, Solid Organ injured in 54 (72%) of cases, followed by hollow viscous injury 19(25.33%) (Table 4). Liver (40% n=30) followed by spleen 28(37.33%) is most common organ injured in case of blunt trauma abdomen (Table 5) (Figure 4).

Blunt trauma to abdomen is critical component for mortality and morbidity, forming an essential component of the initial evaluation of a poly-trauma patient. With advanced diagnostic and treatment modalities, possible risk factors predicting mortality and morbidity in patients of blunt trauma abdomen to be analyzed.

Arumugam et al. [5] found males (93%) were more commonly involved with a mean age group of 30.6(+/-13) years with road traffic accident as most common mode followed by others. 

In this study also, the age group most affected was between 16-30 years (56%), which constitutes most productive group of society followed by age groups of 31-45years (32%). The least affected age group was 46-60years (6.667%). Male: Female ratio in this study was 11.5:1. More affection of male (92%) gender might be contributed to more dominance of male in outdoor activities and their aggressive behaviors. Also, It may be due to greater exposure of males on streets and the personal and behavioural characteristics of males.

Arumugam et al.,5 found males (93%) were more commonly involved with a mean age group of 30.6(+/-13) years. In the similar type of study done M J George et al.,3, Majority of the patients were in the age group of 18-30 years (50%) followed by 20-40 years (31.82%). Out of total 110 patients 80 were male and 30 were female.

Road traffic accident being the most common mode of injury (78.6%) followed by fall from height (14.7%) which was again consistent with the incidence in most studies and literature in western and Indian studies [3,5,6]. Out of this 78.6% Road traffic accident twowheeler vehicle injuries (41.33%) were more common than four-wheeler vehicle injury (10%). Workplace injuries constitute 4% and assault constituted 2.7% of total blunt trauma abdomen injuries. Alcohol consumption at time of injury was found in 2.6% at the time of injury and 86.33% were without safety measure. Surprisingly use of safety measures during driving or at workplace was very much less.

Categorical stratification into high and low velocity injuries was not associated with any statically significant difference with mortality.  In the study by Karamercan et al. [7], of 144 patients with BTA, only 15% had isolated blunt trauma abodomen while 85% had blunt trauma abdomen with multi system injuries. In the same trend our study demonstrated that of the 75 patients included, 7 patients (9.3%) had isolated injuries; while remaining 68 patients (91.7%) had associated injuries to other systems. Chest injuries were present in 33 patients (44%) followed by musculoskeletal injuries in 25 patients (33%), and pelvis injuries in 10 patients (13.3%).

Out of 75 patients of blunt trauma abdomen 56 patients were of solid organ injury and 19 patients were of hollow organ injury Among all solid organs involved liver was most common in total 30 patients (53%) similar to studies conducted by Arumugam et al. [5] where liver injury is 36% and 34% by Solanki et al. [8]. This can be explained as the liver occupies the largest area in abdominal cavity.

There was a striking association between abdominal trauma and male patients. Most of them were from young and productive age group. Road traffic accident was the most common mode of injury. The liver was the most frequently injured organ in our studied populations. High velocity remained another associated factor for blunt abdominal trauma. Most of BTA patients had an associated injury and chest injuries were the most commonly associated injury. This study calls for improving motor vehicle safety, development of roads and bridge network, activation of traffic laws, and raising the educational level of drivers and general populations. Moreover, the general population should have good knowledge about traffic laws. Rapid emergency transport of victims and rapid intervention should help to reduce the mortality and morbidity associated with the public health problem.

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