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A characterization of trauma laparotomies in a scandinavian setting: an observational study



Despite treatment advances, trauma laparotomy continuous to be associated with significant morbidity and mortality. Most of the literature originates from high volume centers, whereas patient characteristics and outcomes in a Scandinavian setting is not well described. The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a Scandinavian setting and compare this to international reports.


A retrospective study was performed in the Copenhagen University Hospital, Rigshospitalet (CUHR). All patients undergoing a trauma laparotomy within the first 24 h of admission between January 1st 2019 and December 31st 2020 were included. Collected data included demographics, trauma mechanism, injuries, procedures performed and outcomes.


A total of 1713 trauma patients were admitted to CUHR of which 98 patients underwent trauma laparotomy. Penetrating trauma accounted for 16.6% of the trauma population and 66.3% of trauma laparotomies. Median time to surgery after arrival at the trauma center (TC) was 12 min for surgeries performed in the Emergency Department (ED) and 103 min for surgeries performed in the operating room (OR). A total of 14.3% of the procedures were performed in the ED. A damage control strategy (DCS) approach was chosen in 18.4% of cases. Our rate of negative laparotomies was 17.3%. We found a mortality rate of 8.2%. The total median length of stay was 6.1 days.


The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort is comparable to reports from similar Western European trauma systems.


Major trauma remains a significant cause of morbidity and mortality. The World Health Organization (WHO) estimates that trauma is the direct cause of 9% of the mortality worldwide [1]. Abdominal trauma accounts for an estimated 10% of the burden of injury in Europe [2]. Although the distinction between blunt and penetrating trauma is important, both frequently require surgical exploration in the form of a trauma laparotomy.

Historically, the mortality rate of patients undergoing trauma laparotomy was 40% [3]. However, more recent literature shows significantly lower mortality rates between 7 and 21% [4,5,6,7,8,9,10]. These favorable outcomes may in part be attributed to recent advances in concepts such as Damage Control Surgery (DCS) and Damage Control Resuscitation (DCR), which is now an integral part of the treatment strategy for critically injured trauma patients to reduce the risk of morbidity and mortality [11,12,13,14,15,16,17].

While these concepts are now widely adopted, differences in protocol adherence as well as the underlying patient demographics, including the percentage of penetrating versus blunt trauma patients, may impact on outcomes [18]. Furthermore, comparisons between centers as well as assessments of the driving factors of adverse outcomes from aggregated trauma databases is difficult, a fact that has been demonstrated when European trauma systems are compared [19].

Understanding of the underlying demographics and adherence to treatment protocols are thus critical when analyzing trauma outcomes. While these factors are well documented for trauma systems in the United Kingdom (UK) and United States (US) [20, 21], less is known about Scandinavian trauma systems.

The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a level 1 trauma center in Denmark. We hypothesize that outcomes and adherence to protocols are comparable with internationally published reports from comparable trauma systems.


This is a retrospective quality assurance study of trauma patients admitted to Copenhagen University Hospital, Rigshospitalet Trauma Centre (CUHR TC) between January 2019 and December 2020. The study was conducted and reported in line with STROBE guidelines.

Access to patient data for the purpose of quality assurance was approved by the local Ethics Board (ID: PID 3714). The CUHR Trauma Centre meets the Level 1 Trauma Centre standards according to the American College of Surgeons. It serves as a regional trauma center for the eastern part of Denmark with a population of 2.6 million people (46% of the Danish population).

Patient selection

We included all patients admitted to the CUHR Trauma Center, both primary and secondary admissions, undergoing a trauma laparotomy (including both in the operating room and trauma bay) within the first 24 h of admission between January 1st 2019 and December 31st 2020. Data were obtained from the local trauma registry and the EPIC electronic health record system (Verona, WI, USA) used within the Capital Region of Denmark.

Study variables

Extracted data included demographics and prehospital data: sex, age, trauma mechanism (blunt/penetrating), Injury Severity Score (ISS) [22], American Society of Anesthesiologists (ASA) score [23], Glasgow Coma Scale (GCS) [24], Abbreviated Injury Scale (AIS) [25], time from injury to arrival at trauma care unit and trauma call duration.

In hospital data included systolic blood pressure at arrival, blood lactate at arrival, radiological procedures performed, blood transfusions, indication for surgery, place of surgery (trauma bay versus designated operating room), time from arrival in the Trauma Center to surgery start, duration of surgery, DCS approach (including indication for DCS), charge of most senior abdominal surgeon, findings during laparotomy, procedures performed as well as hemodynamic status during surgery.

Post laparotomy data included mortality, total number of operations needed in any region, intensive care unit (ICU) length of stay (LOS), hospital LOS, discharge destination to (home, local hospital, nursing home).

Data and statistical analysis

Continuous data are presented as medians (interquartile range (IQR)). Dichotomous and categorial data are presented as percentages. All statistical analyses were performed using Microsoft Excel (Microsoft, Redmond, WA, USA. Version 16.0.14026.20304).

Data integrity and collection

All data were collected by JMB and verified by EPM and SSR. All data were registered in the Research Electronic Data CAPture (RedCAP) system (Vanderbilt University, Nashville, TN, USA).

Missing data

Missing data were considered missing at random. Supplementary table 1 provides an overview of the percentage of missing data points for each registered variable.


During the 2-year study period, 1713 trauma patients were admitted to CUHR. These were either directly admitted (n = 87, 88.8%) or transferred from one of 15 referral hospitals. Of these, 571 (33.3%) had an ISS > 15. Blunt trauma accounted for 83.4%, whereas penetrating injuries accounted for 16.6%. We identified 98 patients eligible for study inclusion after having screened the total number of trauma patients in the study period (1713) and excluded the 1615 who did not have a trauma laparotomy performed. Demographic and injury characteristics data are presented in Table 1.

Table 1 Patient demographics and injury characteristics for the 98 trauma laparotomy patients

In the study population, penetrating trauma was the predominant mechanism of injury (66.3%) (Table 1). Stabbing was the most common mechanism of injury (n = 59, 60.2%), while gunshot wounds only accounted for a minor part of the cases (n = 6, 6.1%). Road traffic collisions was the predominant mechanism in blunt trauma (n = 24, 24.5%). Motor vehicle accidents being most common, followed by pedestrians, cyclists, and motorcycles. The median ISS score within the study population was 13 (16), with 43 (43.9%) having an ISS > 15.

Table 2 provides information on identified injuries and treatments deployed.

Table 2 Identified injury patterns and patient treatment

Frequent injuries included damage to the mesentery of small intestine (n = 24, 24.5%), colon (n = 22, 22.4%), liver/gall bladder (n = 26, 26.5%) and retroperitoneum zone II (n = 22, 22.4%). Damage to duodenum, pancreas, diaphragm, retroperitoneum zone III and fecal contamination were all rare (below 10%). In 17 (17.3%) cases no injuries were identified during surgery. On further investigation of the negative laparotomy cases, 4 (23% of negative laparotomies) were crash laparotomies on exsanguinating patients concurrent with thoracotomies where intraabdominal injury was suspected but not found. The remainder (n = 13, 77% of negative laparotomies) were due to institutional protocols mandating laparotomy following evidence of peritoneal penetration for stab wounds by either diagnostic laparoscopy, clinical examination, or CT findings.

The most frequent interventions were suture of intestine/stomach (n = 31, 31.6%) and intestinal resection (n = 15, 15.3%) followed by hemostatic procedure on the liver (n = 14, 14.3%). Primary anastomosis was made in 8 (8.2%) patients, and primary enterostomy in 1 (1.0%) patient. Abdominal packing was only needed in 16 (16.3%) cases, vacuum assisted closure (VAC) was chosen for 16 (16.3%) patients, and of these 10 patients received both abdominal packing and VAC.

The median amount of transfused blood product was 2000 (3750) ml. 34 patients (34.7%) received Packed Red Blood Cells (PRBC), 37 patients (37.8%) Fresh Frozen Plasma (FFP) and 29 patients (29.6%) Platelets (PLT). Massive transfusion protocol (MTP) was activated in 34 of these patients. Our institution adheres to an MTP protocol dictating 1:1:1 transfusion ratios until viscoelastic guided transfusions are available.

Table 3 provides an overview of postoperative and outcome data. We found a mortality rate of 8.2% (n = 8) with 6 being in the trauma bay and 2 in addition during hospitalization. The median time to death after arrival to the hospital was 46 (135) minutes. The most frequent cause of death was hemorrhage (n = 4, 50%). For patients presenting in hemorrhagic shock, defined as a first measured systolic blood pressure < 90 mmHg in the trauma bay, the overall mortality rose to 31.8%.

Table 3 Postoperative and outcome data

Most patients were admitted to the ICU after the trauma resuscitation and surgery (n = 53, 59.6%), where the median length of stay was 2.0 (6.1) days. The total median length of stay was 6.1 (11.1) days.


Penetrating injury is infrequent in most western European countries, whereas higher rates are seen in the US and South Africa [26, 27]. In the Northern European countries, penetrating trauma is seen in 5–14% [28,29,30,31,32], and 37–58% [29, 33, 34] for patients undergoing trauma laparotomy, with gunshots accounting for 5–36% [28, 35,36,37,38]. In our study, penetrating trauma accounted for 16,6% of the trauma population and 66.3% for patients undergoing laparotomy. This is higher, when compared to European and Scandinavian countries, but is comparable to other countries outside Europe [4, 6, 7, 10, 34, 39,40,41,42,43].

Compared to other studies, our population of predominantly younger males is comparable [4, 6, 7, 10, 34, 39, 40, 43,44,45,46], with ISS being slightly lower than other published cohorts [4, 6, 7, 10, 34, 39, 40, 43, 45, 46]. In terms of injuries, we identified an overrepresentation of bowel-, liver- and stomach injuries, and an overall mortality rate of 8.2%. Internationally, trauma laparotomy mortality rates have been reported between 6 and 21% [4, 6, 7, 10, 34, 39, 43, 45, 46], but care should be taken when comparing these rates, as differences in patient demographics and injury modalities likely impact on results. The reported LOS at the ICU of 2 days and total in-hospital LOS of 6.1 days is in line with previously reported findings [4, 6, 7, 34, 39, 43, 45].

Of interest, mortality rates rose to 31.8% for patients presenting to our hospital in hemorrhagic shock. These rates are lower than rates reported from both US and UK centers, ranging consistently between 46–47% [10, 47], but higher than rates from other US centers reporting a mortality rate of 18%[48]. Although it is tempting to conclude on the lower mortality rates for patients presenting in hemorrhagic shock identified here compared to US and UK reported rates, care should be taken as multiple both treatment and patient demographic factors could have influenced findings. Furthermore, it is important to underline that this study presents data from a limited group of patients, and that variations in mortality rates across the study period could affect the presented data disproportionally.

Collectively, this Danish trauma laparotomy cohort is thus comparable to other European centers in terms of demographics and overall outcomes but seem to differ somewhat in terms of injury modalities, with penetrating trauma accounting for a higher percentage of laparotomy indications. Rather than owing to differences in actual injury modalities, this may also be partly attributed to other factors. One factor is that a greater availability of interventional radiology provides the possibility to omit the need for laparotomy in for instance many blunt liver or splenic injury trauma patients. In this cohort, no laparotomies were preceded by interventional radiology. Another factor is differences in adherence to protocols dictating the need for surgical exploration in patients with suspected abdominal fascia penetration but without associated signs of injuries (e.g., peritonitis or hypotension). This again is underlined by the fact that our negative laparotomy rates (17.3%) are much higher than reported rates of 3.9% from international high-volume centers[49], thus indicating an increased use of this approach in our cohort. Other reports have, however, indicated a wide range in negative laparotomy incidences ranging from 6 to 36% [7, 41, 42, 45, 49,50,51,52,53,54,55]. A further analysis of the negative laparotomy patients revealed that 77% of these were operated solely due to evidence of peritoneal penetration with signs of associated injury, a protocol that remains debatable and not supported by neither the Eastern Association of Trauma (EAST), Western Trauma Association (WTA) or the World Society of Emergency Surgery guidelines [56,57,58].

In terms of the treatment flow, we identified a median time to trauma laparotomy in the ED and OR of 12 (20) minutes and 103 (88) minutes respectively. While no definite limit for time to emergency laparotomy exists, the American College of Surgeons Committee on Trauma (ACS-COT) has previously recommended an audit filter of 2 h [59], with other studies reporting median times from ED admission to surgical start of 24–56 min [10, 40, 44]. The observed delays to OR in this cohort is thus within acceptable limits but could be influenced by the fact that our trauma team also oversee other non-trauma clinical duties when on call, as well as the fact that we do not have a dedicated trauma operating room on 24/7 standby. Of interest, care systems and organizational changes, e.g., a specialist trauma surgeon, have been associated with significantly improved outcomes [21, 43, 60,61,62].

A DCS approach was used in 18% of cases, which is low compared to other studies [7, 10, 34, 39]. While this could potentially reflect an underuse of the DCS approach in otherwise eligible patients, it should be interpreted in the light of the above-mentioned findings of high negative laparotomy rates. In patients where the DCS approach was deployed, duration of surgery was 20 (53) minutes for procedures done in the ED, and 88 (68) minutes for procedures done in the OR, which is reasonably in line with published guidelines and previous reports of average operation times of 62 min [7]. Overall, 14% of patients were operated in the ED, with other reports indicating rates of 22 to 51% [40, 63]. Again, rather than reflecting upon an underuse of ED laparotomies, these rates should be interpreted in the light of the high negative laparotomy rates, thus indicating a difference in the injury severity of patients.

Potentially both negative laparotomy rates as well as overall outcomes could be contingent upon the surgical experience of the care provider team. ACS-COT has set a standard of 35 cases per year per surgeon [64], with studies identifying an association between the average surgeon’s volume of seriously injured patients and mortality for all patients [65], as well as associations between trauma center volume and mortality [65,66,67,68,69,70]. In this cohort, the charge of the most senior surgeon was in 23% of the cases a senior resident, with an estimated annual caseload of 6 trauma laparotomies based on-call frequency and the findings identified here. With a previously reported association between trauma center volume and laparotomy outcomes [71], an outcome benefit could potentially be realized by increasing the caseload for the trauma center as well as individual surgeon through trauma center referral criteria as well as the formation of a dedicated trauma laparotomy team. It is, however, important to underline that the current caseload does not support the notion of forming a dedicated trauma surgery team, and that increased trauma treatment centralization would be required for this to become a realistic option.


The interpretation is limited by the retrospective nature of the data. This makes the study dependent on data quality and granularity, factors that would be optimal if approached through a prospective study. Furthermore, data are derived from a single center, thus no conclusions can be drawn on the overall trauma system in Denmark. Additionally, the study setup does not allow for a direct statistical comparison with other centers, and multiple confounding factors could thus affect results when direct comparisons with reported data from other centers is done. To this end, extended scoring systems in addition to the ISS allowing for center comparisons such as the Trauma Injury Severity Score (TRISS) would have been of value. Unfortunately, available data did not allow for the calculation of this score. Finally, the limited number of trauma laparotomies coupled with the high rate of negative laparotomies is a weakness of the study, and results should be viewed considering this.


The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort, is comparable to reports from similar Western European trauma systems but differ from reports from centers where rates of penetrating traumas are higher. Furthermore, we identified potential areas of quality improvement, where future focus should be directed.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.



Copenhagen University Hospital, Rigshospitalet


Injury Severity Score


American Society of Anesthesiologists Score


Glasgow Coma Scale


Abbreviated Injury Scale


Damage Control Surgery


Vacuum assisted closure


Fresh Frozen Plasma


Packed Red Blood Cells




Operating Room


Emergency Department


American College of Surgeons, Committee on Trauma


  1. World Health Organization. Injuries and violence: The Facts. Geneva; 2014 [cited 2021 Feb 2]. Available from:

  2. Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, et al. The epidemiology and clinical evaluation of abdominal trauma: an analysis of a multidisciplinary trauma registry. Ann Ital Chir. 2010;81(2):95–102.

    PubMed  Google Scholar 

  3. Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77(4):761–77.

    CAS  Article  Google Scholar 

  4. Bowie JM, Badiee J, Calvo RY, Sise MJ, Wessels LE, Butler WJ, et al. Outcomes after single-look trauma laparotomy: a large population-based study. In: Journal of Trauma and Acute Care Surgery. Lippincott Williams and Wilkins; 2019 [cited 2020 Dec 7]. p. 565–70. Available from:

  5. Hasler RM, Nuesch E, Jüni P, Bouamra O, Exadaktylos AK, Lecky F. Systolic blood pressure below 110 mmHg is associated with increased mortality in blunt major trauma patients: multicentre cohort study. Resuscitation. 2011;82(9):1202–7.

    Article  Google Scholar 

  6. Joseph B, Azim A, Zangbar B, Bauman Z, O’Keeffe T, Ibraheem K, et al. Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: analysis of 1030 consecutive trauma laparotomies. In: Journal of Trauma and Acute Care Surgery. Lippincott Williams and Wilkins; 2017 [cited 2020 Dec 7]. p. 328–33. Available from:

  7. Hietbrink F, Smeeing D, Karhof S, Jonkers HF, Houwert M, van Wessem K, et al. Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization. World J Emerg Surg. 2019;14(1).

  8. Clarke A, Murdoch H, Thomas MJ, Cook TM, Peden CJ. Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol. 2011;28(1):16–9.

    Article  Google Scholar 

  9. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variations in mortality after emergency laparotomy: the first report of the UK emergency laparotomy network. Br J Anaesth. 2012;109(3):368–75.

    CAS  Article  Google Scholar 

  10. Harvin JA, Maxim T, Inaba K, Martinez-Aguilar MA, King DR, Choudhry AJ, et al. Mortality after emergent trauma laparotomy: A multicenter, retrospective study. In: Journal of Trauma and Acute Care Surgery. Lippincott Williams and Wilkins; 2017. p. 464–8.

  11. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Vol. 101, British Journal of Surgery. Wiley; 2014 [cited 2020 Dec 7]. p. e109–18. Available from:

  12. Waibel BH, Rotondo MMF. Damage control surgery: it’s evolution over the last 20 years. Revista do Colegio Brasileiro de Cirurgioes. 2012[cited 2020 Dec 8];39(4):314–21. Available from:

  13. Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197(5):532–5.

    CAS  Article  Google Scholar 

  14. Germanos S, Gourgiotis S, Villias C, Bertucci M, Dimopoulos N, Salemis N. Damage control surgery in the abdomen: an approach for the management of severe injured patients. Vol. 6, Int J Surg. 2008. p. 246–52.

  15. Lamb CM, Macgoey P, Navarro AP, Brooks AJ. Damage control surgery in the era of damage control resuscitation. Vol. 113, Br J Anaesthesia. 2014 [cited 2020 Dec 7]. p. 242–9. Available from:

  16. Rotondo M. F, Schwab CW, McGonigal MD, Phillips GR, Fruchterman TM, Kauder DR, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–82; discussion 382–3. Available from:

  17. Lee JC, Peitzman AB. Damage-control laparotomy. Vol. 12, Current Opinion in Critical Care. 2006. p. 346–50.

  18. Dijkink S, Nederpelt CJ, Krijnen P, Velmahos GC, Schipper IB. Trauma systems around the world: a systematic overview. J Trauma Acute Care Surg.; 2017. p. 917–25.

  19. Chesser TJ, Moran C, Willett K, Bouillon B, Sturm J, Flohé S, et al. Development of trauma systems in Europe—reports from England, Germany, the Netherlands, and Spain. OTA Int: Open Access J Orthopaedic Trauma. 2019;2(S1):e019.

  20. Nathens AB, Brunet FP, Maier R v. Development of trauma systems and effect on outcomes after injury. Vol. 363, Lancet. Elsevier; 2004. p. 1794–801.

  21. Lockey DJ. Improved trauma outcomes after the introduction of a trauma system in England. Vols. 2–3, EClinicalMedicine. Lancet Publishing Group; 2018 [cited 2021 Feb 4]. p. 3–4. Available from:

  22. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.

    CAS  Article  Google Scholar 

  23. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373–9.

    CAS  Article  Google Scholar 

  24. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872):81–4.

    CAS  Article  Google Scholar 

  25. AAAM. Abbreviated Injury Scale (AIS) 2015. AAAM; 2015.

  26. van Vugt AB. Pitfalls in penetrating trauma. Acta Chir Belg. 2003;103(4):358–63.

  27. Chowdhury S, Navsaria PH, Edu S, Nicol AJ. The effect of emergency medical services response on outcome of trauma laparotomy at a Level 1 Trauma Centre in South Africa. S Afr J Surg. 2016;54(4):17–21.

    CAS  PubMed  Google Scholar 

  28. Bäckman PB, Riddez L, Adamsson L, Wahlgren CM. Epidemiology of firearm injuries in a Scandinavian trauma center. Eur J Trauma Emerg Surg. 2020;46(3):641–7.

    Article  Google Scholar 

  29. Groven S, Gaarder C, Eken T, Skaga NO, Naess PA. Abdominal injuries in a major Scandinavian trauma center-performance assessment over an 8 year period. J Trauma Manag Outcomes. 2014;8(1).

  30. Hoffmann C, Goudard Y, Falzone E, Leclerc T, Planchet M, Cazes N, et al. Management of penetrating abdominal trauma: what we need to know?. Annales francaises d’anesthesie et de reanimation. 2013 Feb [cited 2022 Jan 2];32(2):104–11.

  31. Lansink KWW, Gunning AC, Leenen LPH. Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands. Eur J Trauma Emerg Surg. 2013;39(4):375–83.

    CAS  Article  Google Scholar 

  32. Pekkari P, Bylund PO, Lindgren H, Öman M. Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden. Scand J Trauma Resusc Emerg Med. 2014;22(1).

  33. Marsden MER, Vulliamy PED, Carden R, Naumann DN, Davenport RA, Nnajiuba HO, et al. Trauma laparotomy in the UK: a prospective national service evaluation. J Am Coll Surg. 2021;233(3):383–94.

    Article  Google Scholar 

  34. van Gool MH, Giannakopoulos GF, Geeraedts LMG, de Lange-de Klerk ESM, Zuidema WP. Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre. Langenbecks Arch Surg. 2015;400(1):83–90.

    Article  Google Scholar 

  35. Störmann P, Gartner K, Wyen H, Lustenberger T, Marzi I, Wutzler S. Epidemiology and outcome of penetrating injuries in a Western European urban region. Eur J Trauma Emerg Surg. 2016;42(6):663–9.

    Article  Google Scholar 

  36. Christensen MC, Nielsen TG, Ridley S, Lecky FE, Morris S. Outcomes and costs of penetrating trauma injury in England and Wales. Injury. 2008;39(9):1013–25.

    Article  Google Scholar 

  37. Inkinen J, Kirjasuo K, Gunn J, Kuttila K. Penetrating trauma; experience from Southwest Finland between 1997 and 2011, a retrospective descriptive study. Eur J Trauma Emerg Surg. 2015;41(4):429–33.

    CAS  Article  Google Scholar 

  38. Saar S, Jorgensen J, Lemma AN, Gaarder C, Naess PA, Leppäniemi A, et al. Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen Study. Eur J Trauma Emerg Surg. 2021.

  39. Weale R, Kong V, Buitendag J, Ras A, Blodgett J, Laing G, et al. Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa. Trauma Surgery Acute Care Open. 2019;4(1).

  40. Groven S, Naess PA, Skaga NO, Gaarder C. Effects of moving emergency trauma laparotomies from the ED to a dedicated OR. Scand J Trauma Resuscitation Emerg Med. 2013;21(1):72.

    Article  Google Scholar 

  41. Henderson VJ, Organ CH, Smith RS. Negative trauma celiotomy. Am Surg. 1993;59(6):365–70.

    CAS  PubMed  Google Scholar 

  42. Miller FB, Cryer HM, Chilikuri S, Creech P, Richardson JD. Negative findings on laparotomy for trauma. South Med J. 1989;82(10):1231–4.

    CAS  Article  Google Scholar 

  43. Schechtman D, He JC, Zosa BM, Allen D, Claridge JA. Trauma system regionalization improves mortality in patients requiring trauma laparotomy. J Trauma Acute Care Surg. 2017;82(1):58–64.

    Article  Google Scholar 

  44. Henderson KIM, Coats TJ, Hassan TB, Brohi K. Audit of time to emergency trauma laparotomy. Br J Surg. 2000;87(4):472–6.

    CAS  Article  PubMed  Google Scholar 

  45. Hajibandeh S, Hajibandeh S, Gumber AO, Wong CS. Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: A systematic review and meta-analysis. Int J Surg. 2016;34:127–36.

    Article  Google Scholar 

  46. Kosola J, Brinck T, Leppäniemi A, Handolin L. Blunt abdominal trauma in a European trauma setting: need for complex or non-complex skills in emergency laparotomy. Scand J Surg. 2020;109(2):89–95.

    CAS  Article  Google Scholar 

  47. Marsden M, Carden R, Navaratne L, Smith IM, Penn-Barwell JG, Kraven LM, et al. Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective. J Trauma Acute Care Surg. 2018;85(3):620–5.

    Article  Google Scholar 

  48. Davis JW, Dirks RC, Jeffcoach DR, Kaups KL, Sue LP, Lilienstein JT, et al. Mortality in hypotensive trauma patients requiring laparotomy is related to degree of hypotension and provides evidence for focused interventions. Trauma Surg Acute Care Open. 2021;6(1):e000723.

  49. Schnüriger B, Lam L, Inaba K, Kobayashi L, Barbarino R, Demetriades D. Negative laparotomy in trauma: are we getting better? Am Surg. 2012;78(11):1219–23.

    Article  Google Scholar 

  50. Cocco AM, Bhagvan S, Bouffler C, Hsu J. Diagnostic laparoscopy in penetrating abdominal trauma. ANZ J Surg. 2019;89(4):353–6.

    Article  Google Scholar 

  51. Uranues S, Popa DE, Diaconescu B, Schrittwieser R. Laparoscopy in penetrating abdominal trauma. World J Surg. 2014;39(6):1381–8.

    Article  Google Scholar 

  52. Haan J, Kole K, Brunetti A, Kramer M, Scalea TM. Nontherapeutic laparotomies revisited. Am Surg. 2003;69(7):562–5.

    PubMed  Google Scholar 

  53. Demetriades D, Vandenbossche P, Ritz M, Goodmann D, Kowalszik J. Non-therapeutic operations for penetrating trauma: early morbidity and mortality. Br J Surg. 1993;80(7):860–1.

    CAS  Article  Google Scholar 

  54. Hasaniya N, Demetriades D, Stephens A, Dubrowskiz R, Berne T. Early morbidity and mortality of non-therapeutic operations for penetrating trauma. Am Surg. 1994;60(10):744–7.

    CAS  PubMed  Google Scholar 

  55. Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma. 2009;66(5):1294–301.

    PubMed  Google Scholar 

  56. Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg. 2022;17(1).

  57. Martin MJ, Brown CVR, Shatz DV, Alam HB, Brasel KJ, Hauser CJ, et al. Evaluation and management of abdominal stab wounds: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2018;85(5):1007–15.

    Article  Google Scholar 

  58. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68(3):721–33.

    PubMed  Google Scholar 

  59. American College of Surgeons Committee on Trauma: Resources for Optimal Care of the Injured Patient. Chicago, Illinois: American College of Surgeons. 1990

  60. Gabbe BJ, Simpson PM, Sutherland AM, Wolfe R, Fitzgerald MC, Judson R, et al. Improved functional outcomes for major trauma patients in a regionalized, inclusive trauma system. Ann Surg. 2012;255(6):1009–15.

    Article  Google Scholar 

  61. Nathens AB, Jurkovich GJ, Rivara FP, Maier RV. Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma. 2000;48(1):25–31.

    CAS  Article  Google Scholar 

  62. Hietbrink F, Houwert RM, van Wessem KJP, Simmermacher RKJ, Govaert GAM, de Jong MB, et al. The evolution of trauma care in the Netherlands over 20 years. Vol. 46, European Journal of Trauma and Emergency Surgery. Springer; 2020 [cited 2020 Dec 7]. p. 329–35.

  63. Ito K, Nakazawa K, Nagao T, Chiba H, Miyake Y, Sakamoto T, et al. Emergency trauma laparotomy and/or thoracotomy in the emergency department: risks and benefits. Trauma Surg Acute Care Open. 2019;4(1):e000269.

  64. Committee on Trauma, American College of Surgeons: Resources for Optimal Care of the Injured Patient. American College of Surgeons; Chicago. 1999.

  65. Konvolinka CW, Copes WS, Sacco WJ. Institution and per-surgeon volume versus survival outcome in Pennsylvania’s trauma centers. Am J Surg. 1995;170(4):333–40.

    CAS  Article  Google Scholar 

  66. Haut ER, Chang DC, Efron DT, Cornwell EE. Injured patients have lower mortality when treated by “full-time” trauma surgeons vs. surgeons who cover trauma “part-time”. J Trauma. 2006;61(2):272–8; discussion 278–9.

  67. Sava J, Kennedy S, Jordan M, Wang D. Does volume matter? The effect of trauma surgeons’ caseload on mortality. J Trauma. 2003;54(5):829–33; discussion 833–4.

  68. Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, et al. Relationship between trauma center volume and outcomes. JAMA. 2001;285(9):1164–71.

    CAS  Article  Google Scholar 

  69. Smith RF, Frateschi L, Sloan EP, Campbell L, Krieg R, Edwards LC, et al. The impact of volume on outcome in seriously injured trauma patients: two years’ experience of the Chicago Trauma System. J Trauma. 1990;30(9):1066–75; discussion 1075–6.

  70. Pasquale MD, Peitzman AB, Bednarski J, Wasser TE. Outcome analysis of Pennsylvania trauma centers: factors predictive of nonsurvival in seriously injured patients. J Trauma. 2001;50(3):465–72; discussion 473–4.

  71. Tang A, Chehab M, Ditillo M, Asmar S, Khurrum M, Douglas M, et al. Regionalization of trauma care by operative experience: does the volume of emergent laparotomy matter? J Trauma Acute Care Surg. 2021;90(1):11–20.

    Article  Google Scholar 

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The project was funded by a grant from the Novo Nordisk Foundation (NNF19OC0055183) to MS.

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JMB, EPM, MHS, PS, and SSR designed the study. JMB and EPM performed the data collection. SSR verified the data. JMB performed the statistical analysis of the data. JMB drafted the manuscript assisted by MHS. All authors contributed to the interpretation of the data and writing of the manuscript. All authors revised the manuscript and approved it in the final form. All authors read and approved the final manuscript.

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Correspondence to Martin Sillesen.

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Access to patient data for the purpose of quality assurance was approved by the local Ethics Board (ID: PID 3714).

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Supplementary Information

Additional file 1. Supplemantary table 1:

Overview of missing data for relevant data points.

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Bentin, J.M., Possfelt-Møller, E., Svenningsen, P. et al. A characterization of trauma laparotomies in a scandinavian setting: an observational study. Scand J Trauma Resusc Emerg Med 30, 43 (2022).

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  • Trauma
  • Abdominal injury
  • Laparotomy
  • Scandinavia
  • Mortality
  • Retrospective cohort