Safety of early mobilization of patients with blunt solid organ injuries

Arch Surg. 2008 Oct;143(10):972-6; discussion 977. doi: 10.1001/archsurg.143.10.972.


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.

MeSH terms

  • Abdominal Injuries / diagnosis
  • Abdominal Injuries / mortality
  • Abdominal Injuries / therapy*
  • Adult
  • Analysis of Variance
  • Cohort Studies
  • Early Ambulation / methods*
  • Early Ambulation / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hemorrhage / mortality
  • Hemorrhage / prevention & control*
  • Humans
  • Injury Severity Score
  • Kidney / injuries
  • Laparotomy / methods
  • Laparotomy / statistics & numerical data
  • Liver / injuries
  • Lung Injury
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Probability
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Safety Management*
  • Sensitivity and Specificity
  • Splenic Rupture / diagnosis
  • Splenic Rupture / mortality
  • Splenic Rupture / therapy
  • Survival Analysis
  • Thoracic Injuries / diagnosis
  • Thoracic Injuries / mortality
  • Thoracic Injuries / therapy*
  • Time Factors
  • Trauma Centers
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / therapy*