Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale

Authors

Ahmad Zeineddin, From the Department of Surgery (A.Z.), Howard University Hospital, Washington, DC; Department of Surgery (A.Z., N.K.D., R.A.K.), Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery (M.A., K.M.S.), Yale University, New Haven, Connecticut; Department of Surgery (G.J., B.M.), University of New Mexico Health Science Center, Albuquerque, New Mexico; Department of Surgery (M.C., A.C.S.), College of Medicine, University of Florida, Jacksonville, Florida; Department of Surgery (B.S.R., M.L.M.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Surgery (N.D.M., C.L.J.), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery (D.L., K.K.), Community Regional Medical Center, UCSF Fresno, Fresno, California; Department of Surgery (C.R.H., N.L.W.), Denver Health, Denver, Colorado; Department of Surgery (J.A.P.-Z., H.M.A.K.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Surgery (W.A.M., L.N.H.), University of California San Diego Health, San Diego; Department of Surgery (G.T.T., K.B.S.), Scripps Memorial Hospital, La Jolla; and Department of Surgery (K.L.S.), Stanford University, Stanford, California.
Gail T. TominagaFollow
Marie CrandallFollow
Mariana Almeida
Kevin M. SchusterFollow
Ghassan Jawad
Baila Maqbool
Abby C. Sheffield
Navpreet K. Dhillon
Brandon S. Radow
Matthew L. Moorman
Niels D. Martin
Christina L. JacovidesFollow
Debra Lowry
Krista Kaups
Chelsea R. Horwood
Nicole L. Werner
Jefferson A. Proaño-Zamudio
Haytham M. KaafaraniFollow
William A. Marshall
Laura N. Haines
Kathryn B. Schaffer
Kristan L. StaudenmayerFollow
Rosemary A. Kozar

Document Type

Article

Publication Title

The journal of trauma and acute care surgery

Abstract

INTRODUCTION: The American Association for the Surgery of Trauma Colon Organ Injury Scale (OIS) was updated in 2020 to include a separate OIS for penetrating colon injuries and included imaging criteria. In this multicenter study, we describe the contemporary management and outcomes of penetrating colon injuries and hypothesize that the 2020 OIS system correlates with operative management, complications, and outcomes. METHODS: This was a retrospective study of patients presenting to 12 Level 1 trauma centers between 2016 and 2020 with penetrating colon injuries and Abbreviated Injury Scale score of <3 in other body regions. We assessed the association of the new OIS with surgical management and clinical outcomes and the association of OIS imaging criteria with operative criteria. Bivariate analysis was done with χ 2 , analysis of variance, and Kruskal-Wallis, where appropriate. Multivariable models were constructed in a stepwise selection fashion. RESULTS: We identified 573 patients with penetrating colon injuries. Patients were young and predominantly male; 79% suffered a gunshot injury, 11% had a grade V destructive injury, 19% required ≥6 U of transfusion, 24% had an Injury Severity Score of >15, and 42% had moderate-to-large contamination. Higher OIS was independently associated with a lower likelihood of primary repair, higher likelihood of resection with anastomosis and/or diversion, need for damage-control laparotomy, and higher incidence of abscess, wound infection, extra-abdominal infections, acute kidney injury, and lung injury. Damage control was independently associated with diversion and intra-abdominal and extra-abdominal infections. Preoperative imaging in 152 (27%) cases had a low correlation with operative findings ( κ coefficient, 0.13). CONCLUSION: This is the largest study to date of penetrating colon injuries and the first multicenter validation of the new OIS specific to these injuries. While imaging criteria alone lacked strong predictive value, operative American Association for the Surgery of Trauma OIS colon grade strongly predicted type of interventions and outcomes, supporting use of this grading scale for research and clinical practice. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.

First Page

213

Last Page

219

DOI

10.1097/TA.0000000000003969

Publication Date

8-1-2023

Recommended Citation

Zeineddin, Ahmad; Tominaga, Gail T.; Crandall, Marie; Almeida, Mariana; Schuster, Kevin M.; Jawad, Ghassan; Maqbool, Baila; Sheffield, Abby C.; Dhillon, Navpreet K.; Radow, Brandon S.; Moorman, Matthew L.; Martin, Niels D.; Jacovides, Christina L.; Lowry, Debra; Kaups, Krista; Horwood, Chelsea R.; Werner, Nicole L.; Proaño-Zamudio, Jefferson A.; Kaafarani, Haytham M.; Marshall, William A.; Haines, Laura N.; Schaffer, Kathryn B.; Staudenmayer, Kristan L.; and Kozar, Rosemary A., "Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale" (2023). Surgery. 24.
https://scholar.bridgeporthospital.org/surgery/24

Identifier

37072893 (pubmed); 10.1097/TA.0000000000003969 (doi); 01586154-202308000-00008 (pii)