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Jason A. London, MD, MPH; Lisa Parry, BS; Joseph Galante, MD; Felix Battistella, MD

Arch Surg. 2008;143(10):972-976.

Background  Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage.

Objective  To determine whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries.

Design  Retrospective cohort study. Univariate and multivariate analyses were performed to determine the association of mobilization with delayed hemorrhage of a solid organ requiring laparotomy.

Setting  Level I trauma center.

Patients  Adults with blunt renal, hepatic, or splenic injuries were identified from a trauma registry.

Main Outcome Measures  Medical records were used to determine the day of mobilization and to identify patients with delayed hemorrhage requiring laparotomy.

Results  Four hundred fifty-four patients with blunt solid organ injuries were admitted to the hospital for nonoperative management. Failure rates of nonoperative management were 4.0%, 1.0%, and 7.1% for renal, hepatic, and splenic injuries, respectively. No patients with renal or hepatic injuries failed secondary to delayed hemorrhage. Ten patients (5.5%) with splenic injuries failed secondary to delayed hemorrhage. Eighty-four percent of patients with renal injuries, 80% with hepatic injuries, and 77% with splenic injuries were mobilized within 72 hours of admission. Day of mobilization was not associated with delayed splenic rupture in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.90-1.05).

Conclusions  The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.

Author Affiliations: Division of Trauma and Emergency Surgery, Department of Surgery, University of California, Davis, Sacramento.

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