Reuters Health Information (2008-11-06): Early mobilization safe for patients with blunt solid organ injuries
Early mobilization safe for patients with blunt solid organ injuries
Last Updated: 2008-11-06 10:27:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Patients with blunt injuries of the kidneys, liver or spleen who are managed nonoperatively may be safely mobilized within 72 hours of injury, according to a report in the October issue of the Archives of Surgery.
"A mandatory pre-specified period of bed rest is not indicated for patients with blunt solid organ injuries," Dr. Jason A. London from University of California, Davis, told Reuters Health. "This a piece of dogma that is not evidence based. Early mobilization is safe and encouraged as long as the patient's condition allows."
Dr. London and colleagues investigated whether there is an association between the day of mobilization and rates of delayed hemorrhage from blunt solid organ injuries in 454 trauma patients admitted for nonoperative management at the team's center.
Failures of nonoperative management of blunt solid organ injuries occurred in 4% of renal injuries, 1% of hepatic injuries, and 7.1% of splenic injuries, the authors report.
No renal or hepatic injury patient failed nonoperative management because of bleeding from the solid organ injury, the results indicate, whereas 5.5% of splenic injury patients failed nonoperative management because of bleeding.
At least 30% of renal and hepatic injury patients were mobilized on the first hospital day, 66% to 72% by the second hospital day, and 80% to 84% by the third day. For splenic injuries, 17% of patients were mobilized on the first day, 50% by the second day, and 77% by the third day.
Although a higher proportion of patients who were mobilized later in their hospital course developed delayed splenic rupture compared with those mobilized earlier, a multivariate analysis showed no association between the day of mobilization and the risk of delayed splenic rupture.
"We found that the timing of mobilization of patients with blunt solid organ injuries was not associated with a higher incidence of delayed rupture," the investigators conclude. "Protocols that incorporate a period of strict bed rest are unjustified and may contribute to morbidity, longer hospital lengths of stay, and higher hospital costs."
"One of my partners is looking at the safety of anticoagulation of patients with blunt splenic injuries," Dr. London added. "There are several areas of 'dogma' about treating blunt solid organ injuries which we hope to put some evidence behind. One is the mobilization issue, and the other is the anticoagulation."
Arch Surg 2008;143:972-976.