A review of trauma laparotomy at Christchurch Hospital.

Aim: Trauma is one of the leading causes for years of life lost in New Zealand. Its costs to acute care services alone amount to hundreds of millions per year, and it is the main contributor to years of life lost in patients under 40. Since 2016, the Canterbury Trauma Registry has been actively collecting data on all major traumas presenting to Christchurch hospital. This study will aim to define the demographics of trauma laparotomy patients presenting to Christchurch Hospital, and to assess the relationship between missed injuries (MI) on computed tomography (CT) imaging and time to theatre.

Methods: A retrospective study of trauma patient from June 2016 to February 2019. Data for major trauma patients were supplied from the Canterbury Trauma Registry. Data for minor trauma patients were individually selected from the online operative procedures registry. Non-parametric analysis was undertaken with an independent sample Kruskal-Wallis test alongside pairwise comparisons.

Results: Sixty trauma laparotomies were performed over 36 months, predominantly male gender (43/60) and under 40 years of age (39/60). Motor vehicle accident (31/60) and knife injuries (10/60) were the most common mechanisms. Fourty-three out of sixty patients received pre-operative CT scans. Fourty out of sixty patients received a CT scan within 2 hours. Large bowel injuries (four cases) and small bowel (three cases) were the most common missed injuries on pre-operative CT. Small bowel injuries are the predominate injury in blunt trauma while diaphragm and liver injuries predominated in penetrating trauma. Four patients did not undergo laparotomy within 24 hours. There is a statistically significant difference (p<0.001) in time to operating theatre between patients with no pre-operative CT and patients with no MI on CT and patients with MI on CT. There is no statistically significant difference (p<0.231) in time to operating theatre in patients with no MI on CT and patients with MI on CT.

Conclusion: There is no statistically significant difference in time to operation between trauma laparotomy patients with no MI on pre-operative CT to patients with MI on pre-operative CT. There are recognisable injury patterns in trauma patients. There are delays in trauma patients receiving prompt CT imaging. CT imaging can miss life-threatening injury, close patient observation and further examination, and imaging or operative therapy may be required even if initial imaging is reassuring.