Correlation of abdominal trauma index and injury severity score with abdominal septic complications in penetrating and blunt trauma

The Abdominal Trauma Index (ATI) was designed to stratify patients with penetrating injuries, and has been used to classify patients with blunt trauma. The Injury Severity Score (ISS) was originally designed to stratify victims of blunt trauma, and it has also been used for victims of penetrating trauma. We attempted to validate the use of ISS and ATI for both penetrating and blunt trauma. A total of 592 penetrating and 334 blunt trauma patients who underwent laparotomy over a 5-year period were evaluated. The overall rate of abdominal sepsis was 7.5% for blunt trauma and 7.6% for penetrating trauma. Mortality (excluding deaths within 48 hours) was 7% for blunt trauma and 1% for penetrating trauma. In the penetrating injury population, an ATI value >15 and an ATI value >25 were significantly associated with abdominal septic complications (ASCs) (p < 0.001, both comparisons). An ISS > 16 was also associated with ASCs (p < 0.001). The ASC rate for gunshots was higher than that for stab wounds (11% vs. 2%; p < 0.001). In the blunt group, an ATI value >15 and an ATI value > 25 were associated with ASCs (p < 0.01 and p < 0.001, respectively). The association of ASCs and ISS was linear with increasing ISS in patients with blunt abdominal trauma. The mean ATI value for ASCs was significantly higher in penetrating injuries (30) than in blunt injuries (21; p < 0.003), but the mean ISS for ASCs was higher in blunt than penetrating injuries (35 vs. 23; p < 0.001). We conclude that the ATI is a valid predictor of ASCs in both penetrating and blunt trauma. Victims of gunshot wounds have a significantly greater incidence of ASCs than victims of stab wounds. The ISS is directly proportional to the ASC rate in blunt trauma, indicating a contribution of global injury to the development of ASCs.