The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989-2013

D A O'Reilly, O Bouamra, A Kausar, D J Malde, E J Dickson, F Lecky

    Research output: Contribution to journalArticlepeer-review

    Abstract

    INTRODUCTION: Pancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989-2013.

    METHODS: The Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both.

    RESULTS: Of 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14-35) for blunt trauma and 14 (IQR: 9-18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation.

    CONCLUSIONS: Isolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.

    Original languageEnglish
    Pages (from-to)125-30
    Number of pages6
    JournalAnnals of the Royal College of Surgeons of England
    Volume97
    Issue number2
    DOIs
    Publication statusPublished - Mar 2015

    Keywords

    • Accidents, Traffic/statistics & numerical data
    • Adolescent
    • Adult
    • Age Distribution
    • Blood Pressure
    • Duodenum/injuries
    • Female
    • Humans
    • Injury Severity Score
    • Intensive Care Units
    • Length of Stay/statistics & numerical data
    • Male
    • Middle Aged
    • Multiple Trauma/epidemiology
    • Pancreas/injuries
    • Patient Admission/statistics & numerical data
    • Registries
    • Sex Distribution
    • United Kingdom/epidemiology
    • Wounds, Nonpenetrating/diagnosis
    • Wounds, Penetrating/diagnosis
    • Young Adult

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