Clinicopathological Characteristics Associated with Failure of Nonoperative Management of Blunt Abdominal Trauma at Kenyatta National Hospital

Background: Nonoperative management (NOM) is the preferred initial approach for haemodynamically stable patients with blunt abdominal trauma (BAT), but a substantial proportion of patients fail NOM and require surgical intervention. Data describing the clinicopathological characteristics associated with NOM failure in resource-limited settings such as Kenya remain scarce. Objective: This study aimed to identify the clinicopathological characteristics associated with failed NOM among patients with BAT at Kenyatta National Hospital (KNH). Methods: A retrospective cohort study reviewed the medical records of patients managed nonoperatively for BAT at KNH between June 2017 and June 2024. Systematic sampling was used to select 188 eligible patients. Demographic, clinical, injury-related and radiological characteristics were extracted using a structured data-collection tool and analysed in SPSS version 27, with multiple linear regression used to identify characteristics associated with failure. Results: Most patients were male (87.0%) and aged 19–39 years (74.9%), with road traffic accidents accounting for 79.8% of injuries. Advanced age (p = 0.004), blood transfusion requirement (p = 0.016), a lower Glasgow Coma Scale score (p = 0.036), presence of comorbidities (p = 0.006), mechanism of injury (p = 0.031), and the presence (p = 0.045) and size (p = 0.007) of hemoperitoneum on imaging were significantly associated with failure of NOM. Conclusion: Advanced age, transfusion requirement, depressed consciousness, comorbidities, injury mechanism and hemoperitoneum on imaging are the principal clinicopathological characteristics associated with failure of NOM among patients with BAT at KNH and should inform patient-selection criteria for nonoperative treatment.