Penetrating abdominal trauma. Difference in hematic biometry pre and postsurgical
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This study analyzed differences between pre-surgical and post-surgical levels of hemoglobin, platelets, leukocytes, and other blood markers in 93 patients with penetrating abdominal trauma who underwent exploratory laparotomy at a hospital in Ciudad Juarez, Mexico. The study found higher mean levels of hemoglobin, hematocrit, platelets, and leukocytes in pre-surgical tests compared to post-surgical tests, with the exception of neutrophils which increased slightly after surgery. While not conclusive, the study provides initial baseline data on expected blood marker levels before and after surgery for penetrating abdominal trauma. Larger multi-institutional studies are still needed to establish more reliable standard values.
Penetrating abdominal trauma. Difference in hematic biometry pre and postsurgical
- 1. Revista Médica Revista Médica MD Penetrating abdominal trauma: Difference in hematic biometry pre and post-surgical at the Hospital General de Ciudad Juarez in Chihuahua, Mexico Enríquez-Domínguez Lenin, Díaz-Rosales Juan de Dios y Romo-Martínez Jesús E. Correspondence: Lenin Enríquez Domínguez. Calle de los Alamos 9741, Fracc. Álamos, C.P. 31125, Chihuahua, Chihuahua, MX. Cell phone: (656) 1071340 E-mail: lenin_enriquez@hotmail.com Keywords: Abdominal injury, blood platelets, hemoglobin, leucocyte count, penetrating, wounds. REVISTA MÉDICA MD, Año 6, número 1, agosto - octubre 2014, es una publicación trimestral editada por Roberto Miranda De La Torre, Sierra Grande 1562 Col. Independencia, Guadalajara, Jalisco, C.P. 44340. www.revistamedicamd.com, md.revistamedica@gmail.com. Editor responsable: Javier Soto Vargas. Reservas de Derecho al Uso Exclusivo No. 04-2013- 091114361800-203. ISSN: 2007-2953. Licitud de Título y Licitud de Contenido: en Trámite. Responsable de la última actualización de este número Comité Editorial de la Revista Médica MD Sierra Grande 1562 Col. Independencia, Guadalajara, Jalisco, C.P. 44340. Fecha de última modificación 31 de octubre de 2014. 2014 6(1):30-33pp Publicado en línea 01 de noviembre, 2014; www.revistamedicamd.com
- 2. Penetrating abdominal trauma: Difference in hematic biometry pre and post-surgical at the Hospital General de Ciudad Juarez in Chihuahua, Mexico Abstract Artículo original a b c Enríquez-Domínguez L , Díaz-Rosales JD , Romo-Martínez JE Revista Médica MD 31Volumen 6, número 1; agosto - octubre 2014 Introduction Hematic biometry is the most used laboratory exam in the emergency room in every general or trauma hospital. Objective To analyze and compare the levels of hemoglobin, hematocrit, platelets, leukocytes, and neutrophilia in both pre-surgical and post-surgical levels in penetrating abdominal trauma patients. Material and Methods This is a descriptive and prospective study in patients with penetrating abdominal trauma that underwent exploratory laparotomy. The variables analyzed were: age, gender, type of trauma, pre- surgical and post-surgical count of hemoglobin; hematocrit; platelets; leucocytes; neutrophilia; perioperative bleeding, mortality, and hospital stay. Results Of 508 patients studied, only 93 patients were included. The mean of age was 29.6 years old. 87 patients were males. 32 patients (34.4%) were SW injured whereas 61 (65.6%) were GW injured. According to the type of trauma: 78 patients (83.9%) underwent therapeutic laparotomy, 11 patients (11.8%) underwent non-therapeutic laparotomy, and 4 patients (4.3%) underwent damage control surgery. There were differences between pre-surgical and post-surgical levels, with major levels in pre- surgical means. Discusión Presented values, represent the beginning of a major and multi-institutional study to show real and reliable values that we can expect in a patient with penetrating abdominal trauma during pre-surgical and post-surgical time. We cannot conclude that these data are conclusive; however these data can guide on the levels that we can expect in a multi-institutional study with a major number of patients. Keywords:Abdominalinjury,bloodplatelets,hemoglobin,leucocytecount,penetrating,wounds. a. Servicio de Cirugía General, Hospital GeneraldeCiudad Juárez, Universidad AutónomadeCiudad Juárez, MX. b. División de postgrado Universidad AutónomadeCiudad Juárez, MX. c. Servicio de Epidemiologia, Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, MX. Correspondence Lenin Enríquez Domínguez. Calle de los Alamos 9741, Fracc. Álamos, C.P. 31125, Chihuahua, Chihuahua, MX. E-mail: lenin_enriquez@hotmail.com
- 3. compared pre-surgical and post-surgical measures. Results Of 508 patients studied, only 93 patients were included. The mean of age was 29.6 (SD 10.4) years old; age range from 15 to 68 years. 87 patients (93.5%) were males and 6 patients (6.5%) were females (ratio M:F, 14.5:1). 32 patients (34.4%) were SW injured whereas 61 (65.6%) were GW injured. According to the type of trauma: 78 patients (83.9%) underwent therapeutic laparotomy, 11 patients (11.8%) underwent non-therapeutic laparotomy, and 4 patients (4.3%) underwent damage control surgery. 3 The mean of pre-surgical leukocytosis was 15,130/mm (SD 4,475); mean of neutrophilia was 72.4%; mean of hemoglobin was 13.8 g/dL, mean of hematocrit was 41,2% 3 and mean of platelets was 285,500/mm . The mean of post- 3 surgical leukocytosis was 11,700/mm , mean of neutrophilia was 74.2%, mean hemoglobin was 11.1 g/dL, mean of hematocrit was 32.8%, and the mean of platelets was 3 204,800/mm (see Table 1). The mean of perioperative bleeding was 720 mL (Ranging from 50 to 2500 ml). There were a total of 7 deaths; 5 by sepsis, and 2 by cardiac arrest. The mean of hospital stay was 6.5 days (±4.7); the mean of hospital stay for patients that were discharged for health improvement was 5.9 days, while the mean of hospital stay for dead patients was 9 days. Discussion Patients included in this study, had an age mean of 29.6 (±10.4) years (economic active population), this situation has been observed in others similar studies, and having a similar 7-10 male:female (14.5:1) ratio. However, the major incidence of patient with penetrating trauma in our Hospital and in our city (considered the most dangerous city in the world from 2008 to 2011), is the result of the social and economic problems this part of the country is having. We have a major incidence of GW vs SW injuries (58.8% vs. 41.2% respectively), results that are different to other reports of different regions of the country and the rest of Latin 6-10 America. Nevertheless, the lack of reports in hospitals in other states of the Mexican republic could not show a real statistics of penetrating trauma. Introduction Although violence index has diminished, penetrating abdominal trauma (PAT) continues to be a Public Health 1 Problem in Ciudad Juarez, Mexico. This city has a murder 2 rate of 148 per 100,000 people , and the Hospital General de Ciudad Juárez (HGCJ) remains the main Medical Center of reference of patients with this pathology. In this Medical Center, all traumatized patients are examined initially in the emergency room (ER), and classified according to their severity. Analysis of each patient is based on observation and physical examination by an emergency specialist and a trauma surgeon. Radiographies and blood samples are taken into the first minutes in hospital setting. However, some patients according to the findings in the physical exploration and the presence of hemodynamic instability need to undergo exploratory laparotomy immediately and receive adequate treatment even without standard laboratory results. Analysis of standard laboratory tests in PAT is a very used tool. However, this tool has not been measured, compared or researched, because the lines of research in the majority of medical centers are based on new forms of diagnostic. Without any doubt, hematic biometry is the most used laboratory exam in the emergency room in every general or 3,4 trauma hospital. The purpose of this study is to assess pre and post-surgical levels of leucocytes, neutrophilia, hemoglobin, hematocrit, and platelets in patients with PAT that underwent exploratory laparotomy. Material and Methods This was a prospective and descriptive study conducted at the Hospital General de Ciudad Juárez, a second health care level, from April 1st 2008 to December 1st, 2010. The local institutional review board of the Universidad Autónoma de Ciudad Juárez (UACJ) approved this study. The inclusion criteria were patients age ≥15 years, with primary admission for stab wound (SW) injury and gunshot wound (GW) injury who undergo for exploratory laparotomy. Patients were excluded from our study if they had not a complete file (lack of pre-surgical and/or post-surgical hematic biometry) and those who received a transfusion with any compound of blood pre-surgery, trans-surgery and post- surgery. The variables analyzed were: age, gender, type of injury, pre-surgical and post-surgical levels of hemoglobin, neutrophilia, platelets and leucocytes, perioperative bleeding, mortality and hospital stay. Complete blood count, including hemoglobin level, hematocrit, leucocytes count, neutrophillia, and platelet count were routinely studied in all patients, at ER arrival and post-surgical intervention. All parameters were measured at the same hematology laboratory. Exploratory laparotomy was divided into 4 categories: 1) therapeutic laparotomy, 2) non-therapeutic 5-9 laparotomy, 3) negative laparotomy and 4) damage control 6-10 surgery. Demographic and clinical data are presented as mean and standard deviation (SD) or median with inter quartile range (IQR) for continuous variables according to the underlying distribution and as percentages for categorical variables. We Enríquez-Domínguez y cols. Penetrating abdominal trauma:Difference in hematic biometry pre and post-surgical Revista Médica MD 32Volumen 6, número 1; agosto - octubre 2014 Table 1. Pre-surgical and post-surgical values in patients with penetrating abdominal trauma Source: Surgery Service, General Hospital of Ciudad Juárez Variable Pre-surgery Post-surgery Difference 3 Leucocytes (/mm ) 15,130 11,700 3,430 Neutrophilia (%) 72.4 74.2 1.8 Hemoglobin (g/dL) 13.8 11.1 2.7 Hematocrit (%) 41.2 32.8 8.4 3 Platelets (/mm ) 285,500 204,800 80,700
- 4. in trauma patients because of the time needed for plasma levels to equilibrate, or may be confounded by crystalloid- related hemodilution. Conclusions Presented values, represent the beginning of a major and multi-institutional study to show real and reliable values that we can expect in a patient with penetrating abdominal trauma during pre-surgical and post-surgical time. We cannot conclude that these data are conclusive; however these data can guide on the levels that we can expect in a multi- institutional study with a major number of patients. The levels between laboratory parameters measured in these patients were major in the pre-surgical determination. 3 We observed a decreased level of leukocytes (3,430/mm ): an augmentation in the level of neutrophilia (1.8%): a decreased level of hemoglobin (2.7 g/dL): a decreased level of hematocrit (8.4%): and finally, a decreased levels of platelets 3 (80.700/mm ) in the post-surgical determination. We describe that laboratory values measured tended to lower, except neutrophilia. However, these values had not been previously measured, and with this work, we hope to cooperate to establish a standard values in both, pre and post- surgical states. Today, groups discuss if levels of hemoglobin obtained shortly after injury may or not detect occult bleeding Penetrating abdominal trauma:Difference in hematic biometry pre and post-surgical Revista Médica MD 33Volumen 6, número 1; agosto - octubre 2014 Referencias bibliográficas 1. Díaz-Apodaca BA, De Cosio FG, Moye-Elizalde G, Fornelli-Laffon FF. Discharges for external injuries from a hospital in Ciudad Juarez, Mexico. Rev Panam SaludPublica 2012 ;31(5 ):443-446. 2. O'Connor E. Mexico's Ciudad Juárez Is No Longer the Most Violent City in the World. Time, Oct. 15, 2012 http://newsfeed.time.com/2012/10/15/mexicos- ciudad-juarez-is-no-longer-the-most-violent-city-in- the-world/#ixzz2R9nh5F8W 3. Almaguer C. Interpretación clínica de la biometría hemática. MedUniver 2003 ;5(18): 35-40. 4. Hurtado R, Mellado Y, Flores G, Vargas P. Semiología de la citometría hemática. Rev Fac Med UNAM 2010; 53(4): 36-43. 5. Ertekin C, Yanar H, Taviloglu K, Güloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. EmergMedJ. 2005; 22(11): 790-794. 6. Enríquez-Domínguez L, Díaz-Rosales JD, Herrera- Ramírez F, Castillo-Moreno JR. Cirugía de control de daño. Experiencia inicial en el Hospital General de Ciudad Juárez, México, durante el periodo de abril del 2008 a diciembre del 2010. Med UIS 2011; 24(2): 195-199. 7. Castillo-Moreno JR, Enríquez-Domínguez L, Herrera-Ramírez F, Díaz-Rosales J. Laparotomía no- terapéutica en trauma penetrante abdominal y su relación con el estado de intoxicación por alcohol y drogas. CirGen. 2011; 33(4): 232-5. 8. Senado-Lara I, Castro-Mendoza A, Palacio-Vélez F, Vargas-Ávila AL. Experiencia en el manejo del abdomen agudo de origen traumático en el Hospital Regional “General Ignacio Zaragoza”.CirCiruj. 2004; 72: 93-7. 9. Pinedo-Onofre JA, Guevara-Torres L, Sánchez- Aguilar JM. Trauma abdominal penetrante. CirCiruj. 2006; 74: 431-42. 10. Senado-Lara I, Castro-Mendoza A, Palacio-Vélez F, Vargas-Ávila AL. Experiencia en el manejo del abdomen agudo de origen traumático en el Hospital Regional “General Ignacio Zaragoza”. CirCiruj. 2004; 72 :93-7. Enríquez-Domínguez y cols.