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EDITORIAL
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 91-92

Nonoperative management of trauma


Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication20-Apr-2017

Correspondence Address:
Thamer Nouh
Department of Surgery, College of Medicine, King Saud University, P. O. Box 7805-37, Riyadh 11421
Kingdom of Saudi Arabia
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DOI: 10.4103/sjmms.sjmms_34_17

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How to cite this article:
Nouh T. Nonoperative management of trauma. Saudi J Med Med Sci 2017;5:91-2

How to cite this URL:
Nouh T. Nonoperative management of trauma. Saudi J Med Med Sci [serial online] 2017 [cited 2017 Apr 26];5:91-2. Available from: http://www.sjmms.net/text.asp?2017/5/2/91/204870

Injury represents one of the largest public health issues worldwide. More than 100 million people around the world sustain injury every year,[1] making trauma a serious public health problem. In its “Global Burden of Disease,” the World Health Organization identified injury as one of the most important contributors to years of life lost and years lost due to disability, thereby having a serious social and economic impact across societies. This impact is predicted to expand to constitute a significant proportion of the total societal health burden by 2030.[2]

This is especially true in Saudi Arabia, where there has been a multiple fold increase in the number of injuries and deaths over the past decades.[3] In its 2014 report, the Saudi Ministry of Health reported that injury, poisoning and external causes were the leading causes of death, accounting for 17.8% of all deaths in the country.[4]

There has been a major shift in the management of trauma. Injuries that previously necessitated operative exploration and intervention are now routinely managed in a nonoperative approach, with operative intervention being reserved for patients who are overtly unstable or fail nonoperative management.[5],[6],[7] This shift toward nonoperative management is fueled by the successes observed in managing selected trauma victims and decreasing failure rates of nonoperative management secondary to advances in percutaneous interventional techniques such as angioembolization and percutaneous drainage.[8],[9],[10],[11]

This shift toward nonoperative management complicates what used to be a simple decision to take the patient to the operating room for surgical exploration. It also creates a need for highly specialized professionals in resuscitation medicine. These professionals are expected not only to offer surgical management when needed, but also to identify patients who are at risk of failing nonoperative management as early as possible.

This increased complexity of managing trauma patients has necessitated the establishment of a trauma system, in which trauma surgeons provide care to patients in collaboration with other trauma-trained health-care professionals. This trauma system is associated with improved outcomes and a reduction in the burden of disability and mortality suffered within the community.[12],[13],[14],[15]

In this issue, Dr. Alghamdi reviews the current management options of liver trauma, emphasizing when nonoperative management should and should not be offered for one of the most commonly injured organs.

 
  References Top

1.
Holder Y, Peden M, Kurg E, Lund J, Gururaj G, Kobusingye O. Injury Surveillance Guidelines. Geneva: World Health Organization; 2001. Available from: http://www.who.int/violence_injury_prevention/media/en/136.pdf. [Last accessed on 2017 Feb 02].  Back to cited text no. 1
    
2.
Mathers C, Fat DM, Boerma JT. The Global Burden of Disease: 2004 Update. Geneva, Switzerland: World Health Organization; 2008.  Back to cited text no. 2
    
3.
Al-Naami MY, Arafah MA, Al-Ibrahim FS. Trauma care systems in Saudi Arabia: An agenda for action. Ann Saudi Med 2010;30:50-8.  Back to cited text no. 3
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4.
Ministry of Health. Health Statistical Yearbook. Kingdom of Saudi Arabia, 2014. Riyadh: Ministry of Health; 2014.  Back to cited text no. 4
    
5.
van Haarst EP, van Bezooijen BP, Coene PP, Luitse JS. The efficacy of serial physical examination in penetrating abdominal trauma. Injury 1999;30:599-604.  Back to cited text no. 5
    
6.
Brooks AJ, Rowlands BJ. Blunt abdominal injuries. Br Med Bull 1999;55:844-55.  Back to cited text no. 6
    
7.
Al-Mulhim AS, Mohammad HA. Non-operative management of blunt hepatic injury in multiply injured adult patients. Surgeon 2003;1:81-5.  Back to cited text no. 7
    
8.
Petrowsky H, Raeder S, Zuercher L, Platz A, Simmen HP, Puhan MA, et al. A quarter century experience in liver trauma: A plea for early computed tomography and conservative management for all hemodynamically stable patients. World J Surg 2012;36:247-54.  Back to cited text no. 8
    
9.
David Richardson J, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: A 25-year perspective. Ann Surg 2000;232:324-30.  Back to cited text no. 9
    
10.
Misselbeck TS, Teicher EJ, Cipolle MD, Pasquale MD, Shah KT, Dangleben DA, et al. Hepatic angioembolization in trauma patients: Indications and complications. J Trauma 2009;67:769-73.  Back to cited text no. 10
    
11.
Asensio JA, Demetriades D, Chahwan S, Gomez H, Hanpeter D, Velmahos G, et al. Approach to the management of complex hepatic injuries. J Trauma 2000;48:66-9.  Back to cited text no. 11
    
12.
Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J. A statewide system of trauma care in Victoria: Effect on patient survival. Med J Aust 2008;189:546-50.  Back to cited text no. 12
    
13.
Gabbe BJ, Biostat GD, Lecky FE, Bouamra O, Woodford M, Jenks T, et al. The effect of an organized trauma system on mortality in major trauma involving serious head injury: A comparison of the United Kingdom and Victoria, Australia. Ann Surg 2011;253:138-43.  Back to cited text no. 13
    
14.
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78.  Back to cited text no. 14
    
15.
Nathens AB, Brunet FP, Maier RV. Development of trauma systems and effect on outcomes after injury. Lancet 2004;363:1794-801.  Back to cited text no. 15
    




 

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