19 - VALIDATING THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA PANCREAS INJURY GRADE USING TRAUMA QUALITY IMPROVEMENT PROGRAM DATA

Objectives: The American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for the pancreas was created in 1990. Our aim was to validate the ability of the AAST-OIS pancreas grade to predict adjuncts to operative management, including endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drain placement.

Methods: We analyzed the Trauma Quality Improvement Program (TQIP) database from 2017-2019, including all patients with a pancreas injury. Outcomes included the rates of mortality, laparotomy, ERCP, and peri-pancreatic or hepatobiliary percutaneous drain placement. Outcomes were analyzed by AAST-OIS, and odds ratios (OR) and 95% Confidence Intervals (CI) were calculated for each.

Results: 3571 patients were included in the analysis. AAST grade was associated with increased rates of mortality and laparotomy at every level (p < 0.05). ERCP rates increased from grade 2 to 3 (OR 4.685, 95% CI 3.254-6.745), were similar between grades 3 to 4 (p>0.05), and decreased from grades 4 to 5 (OR 0.443, CI 0.250-0.788). Likewise, rates of percutaneous drain placement increased from grade 2 to 3 (OR 1.999, CI 1.192-3.353), were similar between grades 3 to 4 (p>0.05), and decreased from grades 4 to 5 (OR 0.266, 0.076-0.934).

Conclusion: Increasing pancreatic injury grade is associated with increased mortality and laparotomy rates at all levels. ERCP and percutaneous drainage procedures are used most in mid-grade (3-4) pancreatic trauma. The decrease in nonsurgical procedures in grade 5 pancreatic trauma is likely secondary to increased rates of surgical management (resection and/or wide drainage). The AAST OIS grade for pancreatic injury can predict mortality and interventions.