Chinese Journal of Traumatology 2009; 12(5):259-262
Original articles
Hospital management of abdominal trauma in Tehran,
Iran: a review of 228 patients
Javad Salimi*, Mohammad Ghodsi, Maryam Nassaji Zavvarh and Ali Khaji
Objective: Today, trauma is a major public health prob-
lem in some countries. Abdominal trauma is the source of
significant mortality and morbidity with both blunt and pen-
etrating injuries. We performed an epidemiological study of
abdominal trauma (AT) in Tehran, Iran. We used all our
sources to describe the epidemiology and outcome of pa-
tients with AT.
Methods: This study was done in Tehran. The study
population included trauma patients admitted to the emer-
gency department of six general hospitals in Tehran during
one year. The data were collected through a questionnaire
that was completed by a trained physician at the trauma
center. The statistical analysis was performed using the
SPSS software (version 11.5 for Windows). The statistical
analysis was conducted using the chi-square and P<0.05
was accepted as being statistically significant.
Results: Two hundred and twenty-eight (2.8%) out of
8 000 patients were referred to the above mentioned centers
T
rauma is the main cause of mortality within the
first four decades of life; it is also the fifth major
cause of mortality in all ages. The major pro-
portion of trauma mortalities occurs in developing coun-
tries and road traffic injuries listed the foremost part of
it.1 In other words, motor car accidents are the 11th
cause of mortality in the world and 90% of the resulting
mortalities occur in countries with middle and low
incomes.2
Injuries are a neglected epidemic in developing
countries, causing more than five millions of deaths each
DOI: 10.3760/cma.j.issn.1008-1275.2009.05.001
Sina Trauma & Surgery Research Center, Tehran Uni-
versity of Medical Sciences, Tehran 11364, Iran (Salimi J,
Ghodsi M, Zavvarh MN, and Khaji A).
*Corresponding author: Tel: 98-21-66717421, Fax: 98-
21-66717449, E-mail: mjsalimi@sina.tums.ac.ir
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. 259 .
with abdominal trauma. One hundred and twenty-five (54.9%)
of the patients were in their 2nd and 3rd decades of life and
189 (83%) of our patients were male. Road traffic accidents
(RTA) were the leading cause of AT with 119 (52.2%) patients.
Spleen was the commonly injured organ with 51 cases. Fol-
lowing the analysis of injury severity, 159 (69.7%) patients
had mild injuries (ISS<16) and 69 (30.3%) patients had se-
vere injuries (ISS=16). The overall mortality rate was 46 (20.2%).
Conclusions: Blunt abdominal trauma is more com-
mon than penetrating abdominal trauma. Road traffic acci-
dents and stab wound are the most common causes of blunt
and penetrating trauma, respectively. Spleen is the most
commonly injured organ in these patients. The mortality
rate is higher in blunt trauma than penetrating one.
Key words: Wounds and injuries; Mortality; Ab-
dominal injuries
Chin J Traumatol 2009; 12(5):259-262
year, roughly equal to the number of deaths from HIV/
AIDS, malaria and tuberculosis combined.3 The crude
mortality rate from accidental injury in rural areas of 13
provinces in the Islamic Republic of Iran from 1993 to
1994 was 4.33 per 1 000 and the number of deaths
resulting from unintentional injuries was 5 213 (10.7%
of all deaths).4
The abdomen is frequently injured after both blunt
and penetrating trauma. Approximately 25% of all trauma
victims will require an abdominal exploration.5 Massive
intra-abdominal hemorrhage following blunt abdominal
injury has been reported to be one of the most impor-
tant causes of early mortality following severe trauma
with overall mortality rates between 4% and 31%.6 We
used all our sources to describe the epidemiology and
outcome of patients with abdominal trauma.
 . 260 .
METHODS
This study was done in Tehran, which has the high-
est population among all cities of Iran (6 758 845 popu-
lation in 1995). Tehran has a high volume of traffic and
therefore traffic accidents occur more than expected.
There is not any specific center for trauma in Tehran
and trauma patients are referred to teaching hospitals
of medical universities. The study population included
AT patients admitted to the emergency department of
six general hospitals in Tehran during one year. The
data were collected through a questionnaire, designed
in Sina Trauma and Surgery Research Center (STSRC).
The questionnaires were completed by a trained physi-
cian at the trauma centers of different geographical re-
gions of Tehran. Among 8 000 patients examined at the
hospitals, we selected the AT cases (228 patients) ad-
mitted to the hospitals. The data obtained included
patient demographics, mechanisms of trauma, injury
severity score (ISS), organ injuries, ICU admission and
treatment outcomes. The injured organs were classi-
fied based on ICD10 (international classification of dis-
ease and related health problems). The statistical analy-
sis was performed using the SPSS software (version
11.5 for Windows). The statistical analysis using the
chi-square and P<0.05 was accepted as being statisti-
cally significant.
RESULTS
Demography
During the one year of the study, 2.9% (228/8000)
of the patients sustained AT. There were 189 (83%)
males and 39 (17.1%) females. Sex difference was sta-
tistically significant in blunt and penetrating traumas
(Table 1). The mean age of the patients was 29 years
±16.5 years (ranging from 2 to 84 years).
One hundred and twenty-five (54.9%) patients were
Table 1. Distribution of trauma relating to sex, ISS, multiple trauma and mortality
Patterns of injury Sex
Female Male <16
Blunt trauma 36 123 100
Penetrating trauma 3 66 60
P values 0.000
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Chinese Journal of Traumatology 2009; 12(5):259-262
in their 2nd and 3rd decades of life. The most common
place of injury occurrence was the road with 146 (64%)
cases followed by home with 33 (14.5%) cases.
Mechanism
The most frequent mechanism of trauma was road
traffic accidents (RTA) in 119 (52.2%) cases, followed
by stab wound and fall with 61(26.8%) and 27(11.8%)
patients, respectively.
The most frequent mechanism of penetrating trauma
was stab wound, and because of the low rate of expo-
sure to firearm in this country, only a few cases of fire-
arm injuries were found (Table 2).
Organ injuries
One hundred and sixteen (50.9%) patients sustained
more than one injury. Abrasion involved in 95 cases
was the most common injury in the abdominal trauma.
Spleen was the commonly injured organ in 51 cases,
followed by kidney, accounting for 37 cases. Liver was
injured in 21 cases while small intestine was injured in
18 cases (Table 3).
Mortality
Forty-six (20.2%) patients succumbed to injury,
among which, 10 (21.7%) were female and 36 (70.3%)
were male. The death of 41 (89.13%) patients was due
to blunt trauma and 5 (10.9%) due to penetrating trauma
and the difference was statistically significant (P<0.05).
Head and abdominal injuries were the main causes of
death with 19 (41.3%) cases followed by pelvic injury,
with 4 (8.6%) deaths, chest injury with 2 (4.3%) deaths
and injury of blood vessels with 2 (4.3%) deaths. Eight
(17.4%) patients died before reaching the hospital, 22
(47.8%) died in the emergency department, 3 (6.5%)
died in surgery wards, 4 (8.7%) died in operating room,
and 9 (19.6%) died in ICU.
ISS Multiple trauma Mortality
=16 Yes No Yes No
59 100 59 41 118
9 16 53 5 64
0.000 0.000 0.001
 Chinese Journal of Traumatology 2009; 12(5):259-262 . 261 .

Table 2. Mechanism of trauma most of their time at home. Similar findings have been
reported in earlier series.7-9 Overloading, poor vehicle
Mechanism of trauma Sex
Female Male maintenance and bad roads are the main factors re-
RTA 26 93 sulting in traffic injuries in developing countries. Because
Fall 6 21 the most frequent mechanism of injury is RTA, any ef-
Blunt objects 4 10 forts to prevent this sort of injury should be of the ut-
58
most value for the prevention of trauma in this society.
Stab wound 3
Other important contributory forces to these injuries are
Firearm 0 7
stab wound, falls, blunt objects, and firearm. These to-
gether include 47.8% of the injuries. Blunt injuries are
Table 3. Frequency of organ injury
2.3 times more frequent than the penetrating injuries,
Injured organs Frequency and these patients tend to be more severely injured.10
Spleen 51 Our preliminary analysis shows that patients with blunt
Liver or gallbladder 21 abdominal trauma should be the focus of attention due
Stomach 3 to the high involvement injuries (Table 1). Spleen is the
most common injured organ, which is similar to many
Small intestine 32
other studies.9,11,12 Splenic injuries occur in 51 cases of
Colorectum 14
the abdominal organ injuries. This is distantly followed
Urinary system 8
by kidney and liver injuries that respectively occur in 37
Kidney 37 and 21 cases of the total. The overall mortality rate is
Ovary 1 20.2% and that is higher than the previous studies in
Retroperitoneum 19 our country (2%) and other countries.10,11 Forty-one of
Mesenterium 16 46 death cases occur in blunt trauma. These data are
probably a reflection of non-existent pre-hospital care
Abdominal wall 3
in Iran, inappropriate means of transporting injured per-
Blood vessels at abdomen and pelvis 9
sons and unsatisfactory hospital-based management.13
This may, as well, be the tip of the iceberg, as the
Severity of injury
absence of an effective emergency response system
On the analysis of injury severity, 159 (69.7%) pa-
may mean that many patients with multiple traumas
tients had mild injuries (ISS<16) and 69 (30.3%) pa-
including blunt abdominal trauma following traffic inju-
tients had severe injuries (ISS ≥ 16). Table 1 shows
ries perish in accident scenes in developing countries.
that patients with penetrating injury are the minority
Prevention of traffic injury will clearly be the best ap-
and tend to be less severely injured. There were 59 and
proach towards reduction of blunt abdominal trauma.
9 cases of severe injury in blunt and penetrating traumas
Two areas towards this achievement are worth
and their difference was statistically significant (P<0.05).
mentioning, construction and maintenance of good roads
and effective enforcement of motor traffic regulations.
DISCUSSION
Motor traffic regulations are flouted with impunity in
many developing countries and this needs serious at-
Trauma to the abdomen in Iran mainly affects young
tention for good engineering design of the roads.
men with 40.8% of the injuries due to RTA. Overall,
males were affected 4.85 times more than females and
In conclusion, blunt abdominal trauma is more com-
the patients aged between 20 to 29 years accounted
mon than penetrating abdominal trauma and road traf-
for 30.3% of the study population. This is the most pro-
fic accident and stab wound are the most common
ductive age group and has grave impact on the national
causes for blunt and penetrating traumas, respectively.
economy and families who depend on these young men
Adult males are the most common victims because
and women for their survival. RTA mostly occurs in males
they have more outdoor activities. Spleen is the most
and this might be due to the socio-cultural pattern of
commonly injured organ in patients. Mortality rate in
our country like many other countries that have a tradi-
blunt trauma is higher than that of penetrating trauma.
tional pattern of family and the majority of women spend

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 . 262 .
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(Received February 1, 2009)
Edited by SONG Shuang-ming