Traumatic Pancreatic Injury Presentation, Management, and Outcome: An Observational Retrospective Study From a Level 1 Trauma Centre in Northern India

Background Pancreatic trauma (PT) is a rare but severe injury often associated with significant morbidity and mortality. Advances in diagnostic imaging and management strategies have led to a paradigm shift toward non-operative management (NOM) in select cases. This study aims to analyze the trends, outcomes, and challenges in the management of PT at a Level I trauma center over four years. Methods A retrospective observational study was conducted on 128 patients treated for PT between January 2021 and December 2024. Patients were categorized based on the American Association for the Surgery of Trauma (AAST) Pancreatic Injury Scale (Grades I-V). Data on demographics, injury characteristics, management strategies (operative vs. non-operative), complications, and outcomes were collected and analyzed. Statistical methods included chi-square tests, logistic regression, and descriptive analysis to evaluate predictors of outcomes and complications. Results Of the 128 patients, 78.9% were managed non-operatively, predominantly Grades I-II injuries, while 21.1% required surgical intervention, primarily for Grades III-V injuries. Complications were observed in 48.4% of patients, with pancreatic fistulas (21.9%) and sepsis (18.8%) being the most common. The mortality rate was 25.8%, with sepsis as the leading cause of death. NOM resulted in shorter hospital stays (median: 9 days, IQR: 7-14) compared to surgical management (median: 18 days, IQR: 12-25). Multivariate analysis identified high-grade injuries (AAST Grades IV-V) and sepsis as significant predictors of mortality. Conclusion The management of PT is increasingly leaning towards non-operative approaches for low-grade injuries, reflecting global trends. However, surgical intervention remains critical for high-grade injuries, especially those involving major ductal disruption or associated organ damage. This study emphasizes the importance of individualized care, early diagnosis, and multidisciplinary management to optimize outcomes.