Impact of referral delays, lack of early transfusion and imaging on mortality in blunt abdominal trauma: A prospective comparative observational study

Background: Blunt trauma abdomen (BTA) and penetrating trauma abdomen (PTA) are major causes of surgical emergencies. PTA is usually recognized early because of external wounds, while BTA is often underdiagnosed at peripheral centers, resulting in delayed referral, lack of imaging, and inadequate transfusion. This study compares BTA and PTA to determine the impact of such systemic delays on mortality. Methodology: A comparative observational study was conducted on 150 patients with abdominal trauma admitted to the SMS Trauma Centre, Jaipur, from March 2024 to March 2025. Patients were categorized into BTA (n = 93) and PTA (n = 57). Demographics, mechanism of injury, radiology, and transfusion at referring centers, referral pathway, and mortality were analyzed. Categorical data were compared using the Chi-square or Fisher’s exact test, and continuous variables with the t-test or Mann–Whitney U test; p < 0.05 was considered significant. Results: Males predominated (85%). The commonest causes were road-traffic accidents and assault. Radiology was performed in only 20.4% of BTA versus 63.2% of PTA cases (p< 0.001). Early transfusion or resuscitation occurred in 29.0% of BTA compared with 75.4% of PTA patients (p < 0.001). Direct referral occurred in 43% of BTA and 86% of PTA cases (p < 0.001). Overall mortality was 16.1% in BTA and 36.8% in PTA (p = 0.007). Within BTA, mortality was lower among patients who underwent radiology (5.3% vs 18.9%; p = 0.274) or received transfusion (7.4% vs 19.7%; p = 0.249), though these differences were not statistically significant. Conclusion: While PTA mortality reflects injury severity, BTA deaths are largely preventable and stem from systemic delays—limited imaging, lack of transfusion, and multiple referrals. Strengthening peripheral centers with imaging and blood-bank facilities and streamlining referral networks could significantly reduce avoidable mortality in blunt abdominal trauma.