Jong, N. de (Nenke) (2019) Time to the operating room matters in management of pancreatic injuries : A multi-institutional national study on the contemporary management of adult pancreatic injury at Level 1 trauma centers in Canada. thesis, Medicine.
Full text available on request.Abstract
Background: Pancreatic injuries are rare, can be difficult to diagnose and often complex to manage despite multiple published guidelines. The literature consists of small, often single centre, case series providing low level of evidence. This study was therefore undertaken to evaluate the contemporary diagnosis and management of pancreatic trauma in a mature trauma system. Methods: This is a multi-institutional retrospective study from 2009 to 2014 including patients from eight Level 1 trauma centers across Canada. All patients with a discharge diagnosis of pancreatic trauma were included. Demographics, injury characteristics, vital signs on admission, details of diagnosis and type of management were collected. Outcomes measured were mortality and pancreatic related morbidity. Results: Two hundred and seventy-nine patients were included in the analysis. The median age was 29 [IQR 21-43], 72% was male and 79% sustained blunt trauma. Pancreatic injury included the following grades: I, 26%; II, 28%; III, 33%; IV, 9%; V, 4%. One hundred and seventy-five patients (63%) underwent an operative intervention, most commonly a distal pancreatectomy (50%). The overall mortality rate was 11%, the pancreatic related complication rate was 25%. Operatively managed patients had a significantly greater risk for development of pancreatic related complication (OR 3.30, 95% CI:1.1, 10.2, p = 0.03) in low grade pancreatic injuries. A delay in operative management doubled the rate of pancreatic fistula (19% vs 46%, p = 0.003) and tripled the rate of pseudocyst (4% vs 15%, p = 0.02). Conclusion: Our data reveals that pancreatic injuries are associated with multi-system injuries and have a high morbidity and mortality. Most patients were diagnosed early with the use of a CT scan. However, the management of pancreatic injuries has demonstrated significant practice variation, emphasizing the importance for standardization of the management of pancreatic injuries.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Flikweert, drs. Elvira and Department of Surgery, Deventer Ziekenhuis Nederland |
| Supervisor name: | Supervisor: and Joos, dr. Emilie MD and Vancouver General Hospital, Department of Surgery Vancouver |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2630 |
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