Clinical Profile, Surgical Management, and Predictors of Mortality Among Patients with Blunt Abdominal Trauma Undergoing Emergency Laparotomy: A Prospective Study.

Abstract

Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma victims in low- and middle-income settings, where road traffic accidents dominate the injury landscape. Timely identification of patients who require emergency laparotomy and recognition of factors that predict adverse outcome remain central to surgical decision-making. Objectives: To describe the clinical profile, spectrum of intra-abdominal injuries, and operative management of patients undergoing emergency laparotomy for BAT, and to identify pre-operative and intra-operative predictors of in-hospital mortality. Methods: A prospective observational study was conducted in the Department of General Surgery, FAME Hospital and Research Institute, Mysore, over a two-month period (15 March 2026 to 15 May 2026). Forty-five consecutive adult patients (≥18 years) who underwent emergency exploratory laparotomy for BAT were enrolled after informed consent. Demographic details, mechanism of injury, admission Glasgow Coma Scale (GCS), systolic blood pressure (SBP), Focused Assessment with Sonography for Trauma (FAST) and contrast-enhanced computed tomography (CECT) findings, Injury Severity Score (ISS), operative findings, procedures performed, transfusion requirements, complications, and 30-day outcomes were recorded on a structured proforma. Data were analysed with SPSS v.25.0 using the χ² test, Fisher exact test, Student t test, Mann–Whitney U test, and stepwise multivariable logistic regression; P < 0.05 was considered significant. Results: The mean age was 34.6 ± 12.8 years and 36 (80.0 %) were male. Road traffic accident was the leading mechanism (28/45, 62.2 %). At presentation, 17 patients (37.8 %) had systolic hypotension (SBP < 90 mm Hg) and 7 (15.6 %) had a GCS ≤ 8. FAST was positive in 39 patients (86.7 %). The spleen (17, 37.8 %), small bowel (14, 31.1 %), and liver (12, 26.7 %) were the most commonly injured organs; 22 patients (48.9 %) had injury to more than one intra-abdominal organ. Splenectomy was performed in 12 patients (26.7 %) and primary bowel repair or resection–anastomosis in 15 (33.3 %). Damage-control laparotomy was employed in 6 patients (13.3 %). Postoperative morbidity occurred in 22 patients (48.9 %); surgical site infection (12, 26.7 %) and pneumonia (7, 15.6 %) were the commonest complications. Overall in-hospital mortality was 17.8 % (8/45). On univariate analysis, admission SBP < 90 mm Hg, GCS ≤ 8, ISS > 25, ≥ 3 organs injured, need for massive transfusion, and time from injury to operation > 6 hours were significantly associated with death. On multivariable logistic regression, admission SBP < 90 mm Hg (adjusted OR 9.4; 95 % CI 1.8–48.7; P = 0.007) and ISS > 25 (adjusted OR 11.2; 95 % CI 2.0–63.4; P = 0.006) remained independent predictors of mortality. Conclusion: Young men injured in road traffic accidents accounted for the bulk of BAT requiring emergency laparotomy at our centre. The spleen and small bowel were the most frequently injured organs. Admission haemodynamic instability, a low GCS, high Injury Severity Score, and delay to definitive operation were closely associated with mortality; among these, haemodynamic status at arrival and overall injury burden emerged as independent predictors. Streamlined pre-hospital transfer, early damage-control resuscitation, and prompt operative intervention are essential to improve survival.