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Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma.

Publication ,  Conference
Brownstein, MR; Bunting, T; Meyer, AA; Fakhry, SM
Published in: J Trauma
March 2000

BACKGROUND: Blunt small bowel injury (SBI) may be difficult to diagnose accurately. Diagnostic delays are associated with increased morbidity and mortality. METHODS: A cross-sectional survey of members of the American Association for the Surgery of Trauma was conducted. A Likert-type multiple-choice scale was used to evaluate use and usefulness of diagnostic and laboratory tests. Data were analyzed by using univariate and multivariate techniques. RESULTS: A total of 461 of the 702 members (68%) surveyed responded, of which 133 members (29%) were excluded because they did not currently manage adult SBI. Of the remaining 328 respondents, 244 members (74%) reported prior experience as the most important influence on their current practice of diagnosing blunt SBI. None of the standard laboratory tests were reported as useful. Seventy-seven percent of respondents use computed tomographic (CT) scan most or all of the time for diagnosis (p < 0.05 compared with other modalities). Most respondents estimated their annual incidence of SBI at 5% with a >15% frequency of delay in diagnosis. Forty-four percent of the respondents estimated the mortality associated with a delay in diagnosis at < or =5%. Respondents varied significantly in their management of the patient with an unreliable abdominal exam and a CT scan finding of isolated free fluid. In patients with head injuries, 28% observe, 12% repeat the CT scan, 42% perform diagnostic peritoneal lavage, and 16% operate. For intoxicated patients, 51% observe, 11% repeat the CT scan, 26% perform diagnostic peritoneal lavage, and 10% operate. A more aggressive approach with diagnostic and operative intervention was significantly (p < 0.05) advocated by respondents practicing without residents, more than 15 years out from residency, or by those with a perception of higher morbidity and mortality from delays in diagnosis. CONCLUSION: There is significant variation in the diagnostic approach to the patient with suspected SBI. The perceived mortality of delayed diagnosis is much less than reported. Those surgeons with more experience or perception of greater morbidity and mortality from a delayed diagnosis are more aggressive. Further investigation into the diagnosis and treatment of this injury is needed.

Duke Scholars

Published In

J Trauma

DOI

ISSN

0022-5282

Publication Date

March 2000

Volume

48

Issue

3

Start / End Page

402 / 407

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Predictive Value of Tests
  • Peritoneal Lavage
  • Middle Aged
  • Male
  • Intestine, Small
  • Humans
  • Female
  • Emergency & Critical Care Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brownstein, M. R., Bunting, T., Meyer, A. A., & Fakhry, S. M. (2000). Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma. In J Trauma (Vol. 48, pp. 402–407). United States. https://doi.org/10.1097/00005373-200003000-00006
Brownstein, M. R., T. Bunting, A. A. Meyer, and S. M. Fakhry. “Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma.” In J Trauma, 48:402–7, 2000. https://doi.org/10.1097/00005373-200003000-00006.
Brownstein, M. R., et al. “Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma.J Trauma, vol. 48, no. 3, 2000, pp. 402–07. Pubmed, doi:10.1097/00005373-200003000-00006.

Published In

J Trauma

DOI

ISSN

0022-5282

Publication Date

March 2000

Volume

48

Issue

3

Start / End Page

402 / 407

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Predictive Value of Tests
  • Peritoneal Lavage
  • Middle Aged
  • Male
  • Intestine, Small
  • Humans
  • Female
  • Emergency & Critical Care Medicine