Introduction: Damage control surgery and damage control resuscitation have reduced mortality in patients with\nsevere abdominal injuries. The shift towards non-operative management in haemodynamically stable patients\nsuffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low\nvolume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence.\nThe aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal\ninjuries over an eight-year period.\nMethods: Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal\ninjuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed\non all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified\nor not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout\nthe period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma\nService (2005) were compared.\nResults: There was a steady increase in admitted patients with abdominal injuries, while the number of patients\nundergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma\nlaparotomies per year. No increase in missed injuries or failures of non-operative management was detected.\nUnadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as\nfor the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in\nTRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study\nperiod.\nConclusion: Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is\nlimited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by\nan increase in number of laparotomies. However, we have demonstrated a stable performance throughout the\nstudy period as visualized by VLAD without an increase in missed injuries or failures of NOM
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