Impact of Solid Organ Injury Severity on Critical Care Resource Use and Clinical Outcomes in Blunt Abdominal Trauma Patients:A Schematic Assessment
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/030Abstract
Background: Solid organ injuries during blunt abdominal trauma (BAT) have a major effect on patient outcomes. This systematic review and meta-analysis aimed to evaluate the impact of solid organ injury severity on critical-care resource use, non-operative management failure, and mortality in patients with blunt abdominal trauma.
Methodology: Research was conducted in PubMed, Scopus, Web of Science, and Google Scholar until November 2025, and included any of the studies involving adult patients and reporting blunt liver, spleen, or kidney injuries. Articles that presented odds ratios (ORs) or adequate information on ICU admission, NOM failure, or mortality were incorporated. A random-effects model was employed for the meta-analyses, using inverse-variance weighting. ORs with 95% confidence interval (CI) were pooled, and I2 measured the heterogeneity. The Newcastle-Ottawa scale was used to assess the risk of bias, and the certainty of evidence was estimated with GRADE. Sensitivity and subgroup analysis have been conducted to examine the soundness of results.
Results: 12 articles were included. Solid organ injuries of high grade were linked to augmented ICU admission/critical-care use (OR 2.95, 95% CI = 1.09-7.99, I2 =92%). There were no statistically significant differences in NOM failure (OR 0.53, 95% CI = 0.06-4.58, I2 =89%) and mortality (OR 1.48, 95% CI = 0.67-3.28, I2 =78%). The overall level of evidence was moderate.
Conclusion: Solid organ injury severity is a predictor of critical-care resource use, whereas there is a less predictable effect on NOM failure and mortality. Individual management according to the grade of an injury, and patients are advised.
References
1. Goedecke M, Kühn F, Stratos I, Vasan R, Pertschy A, Klar E. No need for surgery? Patterns and outcomes of blunt abdominal trauma. Innov Surg Sci 2019 Oct 14;4:100–7. doi:10.1515/iss-2018-0004
2. Braden LA, Minas-Alexander R, Love A, Hashem E, Karuman P, Jones AL. Traumatic pancreatic injuries and treatment outcomes: an observational retrospective study from a high-volume tertiary trauma center. Am J Surg 2025 Apr;242:116142. doi:10.1016/j.amjsurg.2024.116142
3. Kanlerd A, Auksornchart K, Boonyasatid P. Non-operative management for abdominal solid organ injuries: a literature review. Chin J Traumatol 2022 Sep;25:249–56. doi:10.1016/j.cjtee.2021.09.006
4. Mahmood I, Younis B, Alabdallat M, Mathradikkal S, Abdelrahman H, El-Menyar A, et al. Pre- and post-implementation protocol for non-operative management of grade III–V splenic injuries: an observational study. Heliyon 2024 Mar 20;10:e28447. doi:10.1016/j.heliyon.2024.e28447
5. Podda M, De Simone B, Ceresoli M, Virdis F, Favi F, Wiik Larsen J, et al. Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 WSES consensus document. World J Emerg Surg 2022 Oct 12;17:52. doi:10.1186/s13017-022-00457-5
6. Brooks A, Reilly JJ, Hope C, Navarro A, Naess PA, Gaarder C. Evolution of non-operative management of liver trauma. Trauma Surg Acute Care Open 2020 Nov 3;5:e000551. doi:10.1136/tsaco-2020-000551
7. Alanezi T, Altoijry A, Alanazi A, Aljofan Z, Altuwaijri T, Iqbal K, et al. Management and outcomes of traumatic liver injury: a retrospective analysis from a tertiary care center. Healthcare 2024 Jan 6;12:131. doi:10.3390/healthcare12020131
8. Dünser MW, Noitz M, Tschoellitsch T, Bruckner M, Brunner M, Eichler B, et al. Emergency critical care: closing the gap between onset of critical illness and ICU admission. Wien Klin Wochenschr 2024 Dec;136:651–61. doi:10.1007/s00508-024-02374-w
9. Rajsic S, Breitkopf R, Bachler M, Treml B. Diagnostic modalities in critical care: point-of-care approach. Diagnostics 2021 Nov;11:2202. doi:10.3390/diagnostics11122202
10. Bieler D, Paffrath T, Schmidt A, Völlmecke M, Lefering R, Kulla M, et al. Why do some trauma patients die while others survive? A matched-pair analysis from TraumaRegister DGU®. Chin J Traumatol 2020 Aug;23:224–32. doi:10.1016/j.cjtee.2020.05.001
11. Van Ditshuizen JC, Rojer LA, Van Lieshout EMM, Bramer WM, Verhofstad MHJ, Sewalt CA, et al. Level of trauma care and outcomes in severe injuries: a systematic review and meta-analysis. J Trauma Acute Care Surg 2023 Jun;94:877–92. doi:10.1097/TA.0000000000003890
12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021 Mar;372:n71. doi:10.1136/bmj.n71
13. Fekete JT, Gyorffy B. MetaAnalysisOnline.com: an online tool for the rapid meta-analysis of clinical and epidemiological studies. J Med Internet Res. 2025 Mar 6;27:e64016. doi: 10.2196/64016
14. Kaufman EJ, Wiebe DJ, Martin ND, Pascual JL, Reilly PM, Holena DN. Variation in ICU utilization and mortality after blunt splenic injury. J Surg Res 2016 Jun 15;203:338–47. doi:10.1016/j.jss.2016.03.049
15. Mehl SC, Cunningham ME, Streck CJ, Pettit R, Huang EY, Santore MT, et al. Predictors of ICU admission in pediatric blunt abdominal trauma. Pediatr Surg Int 2022 Apr;38:589–97. doi:10.1007/s00383-022-05067-5
16. Mirzamohamadi S, HajiAbbasi MN, Baigi V, Salamati P, Rahimi-Movaghar V, Zafarghandi M, et al. Patterns and outcomes of abdominal injury: a multicenter Iranian study. BMC Emerg Med 2024 May 31;24:91. doi:10.1186/s12873-024-01002-0
17. Bowman JA, Jurkovich GJ, Nuño M, Utter GH. ICU admission for isolated blunt abdominal solid organ injury. J Trauma Acute Care Surg 2020 Mar;88:408–15. doi:10.1097/TA.0000000000002581
18. Evans LL, Williams RF, Jin C, Plumblee L, Naik-Mathuria B, Streck CJ, et al. Intervention rarely needed for children with low-grade solid organ injury. J Trauma Acute Care Surg 2021 Oct 1;91:590–8. doi:10.1097/TA.0000000000003206
19. Pimentel SK, Sawczyn GV, Mazepa MM, da Rosa FGG, Nars A, Collaço IA. Risk factors for mortality in blunt abdominal trauma requiring surgery. Rev Col Bras Cir 2015 Jul-Aug;42:259–64. doi:10.1590/0100-69912015004011
20. Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E, et al. Non-operative management of hepatic/splenic injury: 17-year analysis. World J Emerg Surg 2019 Jun 17;14:29. doi:10.1186/s13017-019-0249-y
21. Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt solid organ injuries: a prospective study. Arch Surg 2003 Aug;138:844–51. doi:10.1001/archsurg.138.8.844
22. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury. J Trauma 2008 Apr;64:943–8. doi:10.1097/TA.0b013e3180342023
23. Osman M, Alam M, Iftikhar M, Khan AG. Conservative management of splenic injury: single-center experience. Cureus 2023 Aug;15:e43014. doi:10.7759/cureus.43014
24. Hashish S. Outcomes of non-operative management in traumatic liver injuries. Ain Shams J Surg 2023 Jan;16:1–18. doi:10.21608/asjs.2023.285696
25. Musetti S, Coccolini F, Tartaglia D, Cremonini C, Strambi S, Cicuttin E, et al. NOM in blunt splenic trauma: ten-year experience. Emerg Care J 2022 Mar;18:10339. doi:10.4081/ecj.2022.10339
26. Kumar A, Sridhar R, Kumar H, Hakeem SA, Khan AV, Anwer M. Blunt abdominal trauma: clinical insights and outcomes. J Trauma Inj 2025 Sep;38:221–31. doi:10.20408/jti.2025.0045
27. Yadollahi M, Fazeli H, Ghasemian M, Yousefi MR, Karajizadeh M, Farajpour H. Incidence and mortality of abdominal trauma in Iran. Health Sci Rep 2025 Jun 23;8:e70941. doi:10.1002/hsr2.70941
28. Petrone P, Perez-Calvo J, Brathwaite CEM, Islam S, Joseph DK. Traumatic kidney injuries: systematic review and meta-analysis. Int J Surg 2020 Feb;74:13–21. doi:10.1016/j.ijsu.2019.12.013
29. Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, et al. Hepatic trauma management: what IRs need to know. Semin Interv Radiol 2020 Mar;37:35–43. doi:10.1055/s-0039-3401838
30. Lyttle BD, Williams RF, Stylianos S. Management of pediatric solid organ injuries. Children 2024 May;11:667. doi:10.3390/children11060667
31. Nzayikorera J. Complications in abdominal trauma management. In: Abdominal Trauma: New Solutions, Old Problems. IntechOpen; 2023 Mar 29. doi:10.5772/intechopen.106229
32. Zeelenberg ML, Oosterwijk PC, Willems HC, Gosens T, Den Hartog D, Joosse P, et al. Shared decision-making for operative vs non-operative management of hip fractures. BMJ Open 2024 Apr 17;14:e083429. doi:10.1136/bmjopen-2023-083429
33. Gopalan PD, Pershad S, Pillay BJ. ICU admission decision-making using a “20 questions” approach. S Afr J Crit Care 2021 Mar;36:398. doi:10.7196/SAJCC.2020.v36i1.398
34. Chen Y, Li W, Wang X, Zhong Q, Abudurexiti A, Qiu Q, et al. Predictors of ICU outcomes in trauma from falls. Int J Emerg Med 2025 Aug 4;18:142. doi:10.1186/s12245-025-00959-4
35. Minami S, Toida C, Shinohara M, Abe T, Takeuchi I. Reverse shock index × GCS predicts emergency intervention in pediatric BAT. J Pediatr Surg Open 2025 Nov;12:100227. doi:10.1016/j.yjpso.2025.100227
36. Oh TK, Song I-A, Jeon Y-T. Impact of GCS on unplanned ICU readmission in surgical patients. Ann Transl Med 2019 Oct 7;7:520. doi:10.21037/atm.2019.10.06
37. Harthi N, Goodacre S, Sampson FC. Age-related changes and challenges in prehospital trauma care. Front Med 2025 Jun 27;12:1588927. doi:10.3389/fmed.2025.1588927
38. Hardcastle TC, Gaarder C, Balogh Z, D’Amours S, Davis KA, Gupta A, et al. ERATIC trauma ethics & systems recommendations. World J Surg 2025 Aug;49:2055–65. doi:10.1002/wjs.70003
39. Wang Z, Rostami-Tabar B, Haider J, Naim M, Haider J. Trauma systems: an operations management review. Adv Rehabil Sci Pract 2025 Jan 16;14:27536351241310645. doi:10.1177/27536351241310645
40. Minaya-Bravo AM, Aguado-Lopez H. Blunt abdominal trauma in children: case and review. J Med Cases 2017 Sep;8:340–6. doi:10.14740/jmc2901w
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