Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

CONTEXT: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications. AIMS: This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS. SETTINGS AND DESIGN: A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA. SUBJECTS AND METHODS: A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts. STATISTICAL ANALYSIS: Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes. RESULTS: Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU), more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level <10 g/dL on admission, ongoing mechanical ventilation, and ICU stay >7 days were moderately associated with a disposition to long-term support facility. CONCLUSIONS: Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers.