Correlation of Non-Operative Management With Imaging Intra-Abdominal Free Fluid and Solid Organ Injury in Stable Haemodynamic Blunt Abdominal Trauma

Farhan Irham Habiby, Dr. dr. Adeodatus Yuda Handaya, Sp.B-KBD

2025 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Pada trauma tumpul abdomen, non-operative management (NOM) selektif lebih dipilih pada pasien dengan hemodinamik stabil. Namun, adanya cairan bebas intra-abdomen (intra-abdominal free fluid/IAFF) pada USG FAST atau contrast-enhanced CT, serta cedera organ padat (solid organ injury/SOI) pada CT, dapat menggeser keputusan awal ke arah intervensi operatif.

Tujuan: Menilai hubungan antara status hemodinamik dan temuan pencitraan (IAFF dan SOI) dengan keputusan awal NOM versus tata laksana operatif pada pasien dewasa dengan trauma tumpul abdomen, serta menilai korelasi antara IAFF dan SOI.

Metode: Penelitian ini merupakan chart review retrospektif dengan desain potong lintang menggunakan total sampling pada pasien dewasa dengan trauma tumpul abdomen di RSUP Dr. Sardjito, Yogyakarta (n=96). Status hemodinamik (stabil vs tidak stabil; stabil didefinisikan sebagai tekanan darah sistolik ?90 mmHg tanpa vasopressor), keberadaan IAFF pada USG FAST dan/atau contrast-enhanced CT, keberadaan SOI pada contrast-enhanced CT, serta keputusan awal tata laksana diekstraksi dari rekam medis. Hubungan antarvariabel dianalisis menggunakan uji Pearson chi-square.

Hasil: Rerata usia pasien adalah 36,55±17,84 tahun, dan 67,7% pasien berada dalam kondisi hemodinamik stabil. IAFF ditemukan pada 55 pasien (57,3%), sedangkan SOI ditemukan pada 78 pasien (81,3%). NOM dipilih pada 51 pasien (53,1%), sedangkan tindakan operasi dilakukan pada 45 pasien (46,9%). Status hemodinamik berhubungan kuat dengan keputusan tata laksana (p<0>NOM, sedangkan 29 dari 31 pasien tidak stabil menjalani operasi. Keberadaan IAFF berhubungan dengan tata laksana operatif (p<0>IAFF positif menjalani operasi, dibandingkan dengan 5 dari 41 pasien dengan IAFF negatif. Keberadaan SOI juga berhubungan dengan tata laksana operatif (p<0>IAFF tidak berkorelasi secara bermakna dengan SOI (x²(1)=0,838; p=0,360). Kesintasan keseluruhan adalah 95,8%, dengan rerata lama rawat inap 7,2 hari.

Kesimpulan: Stabilitas hemodinamik tetap menjadi penentu utama dalam keputusan awal antara NOM dan pembedahan, sedangkan IAFF dan SOI secara bermakna memengaruhi pemilihan tata laksana operatif. Karena IAFF tidak secara andal memprediksi SOI, hasil pencitraan perlu diinterpretasikan bersama status fisiologis dan derajat keparahan cedera, dengan pencitraan ulang bila diindikasikan, untuk menghindari non-therapeutic laparotomy dan mendukung NOM selektif yang aman.

Background: In blunt abdominal trauma, selective non-operative management (NOM) is preferred for hemodynamically stable patients. However, the presence of intra-abdominal free fluid (IAFF) on USG FAST or contrast-enhanced CT, as well as solid organ injury (SOI) on CT, may shift the initial decision toward operative intervention.

Objective: To evaluate the association between hemodynamic status and imaging findings (IAFF and SOI) with the initial decision for NOM versus operative management in adult patients with blunt abdominal trauma, and to assess the correlation between IAFF and SOI.

Method: A retrospective cross-sectional chart review with total sampling was conducted on adult patients with blunt abdominal trauma at RSUP Dr. Sardjito, Yogyakarta (n=96). Hemodynamic status (stable vs unstable; stable defined as systolic blood pressure ?90 mmHg without vasopressors), IAFF on USG FAST and/or contrast-enhanced CT, SOI on contrast-enhanced CT, and the initial management decision were extracted from medical records. Associations were analyzed using the Pearson chi-square test.

Results: The mean age was 36.55±17.84 years, and 67.7% of patients were hemodynamically stable. IAFF was present in 55 patients (57.3%), and SOI was found in 78 patients (81.3%). NOM was selected in 51 patients (53.1%), while surgery was performed in 45 patients (46.9%). Hemodynamic status was strongly associated with management decision (p<0>NOM, whereas 29 of 31 unstable patients underwent surgery. The presence of IAFF was associated with operative management (p<0>IAFF-positive patients underwent surgery, compared with 5 of 41 IAFF-negative patients. The presence of SOI was also associated with operative management (p<0>IAFF was not significantly correlated with SOI (?²(1)=0.838, p=0.360). Overall survival was 95.8%, with a mean length of stay of 7.2 days.

Conclusion: Hemodynamic stability remains the primary determinant in the initial decision between NOM and surgery, while IAFF and SOI significantly influence the choice of operative management. Because IAFF did not reliably predict SOI, imaging findings should be interpreted alongside physiological status and injury severity grading, with repeat imaging when indicated, to avoid non-therapeutic laparotomy and to support safe selective NOM.

Kata Kunci : Blunt abdominal trauma, Non-operative management, Hemodynamic status, Intra-abdominal free fluid, Solid organ injury