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BLUNT ABDOMINAL TRAUMA

These pages are excerpted from the Trauma Resident Handbook, Rhode Island Hospital Department of Surgery, Division of Trauma - updated 2001. The policies herein are intended to serve as guidelines only. Individual circumstances need to be considered as there may be times when it is appropriate or desirable to deviate from these guidelines. These educational guidelines will be reviewed and updated routinely.


Only 5-10% of patients admitted to trauma centers with suspected abdominal injury (motor vehicle crashes, severe crush injuries, falls from heights >10 feet, or patients with bdominal tenderness) will have abdominal injury. The rate of abdominal injury is twice as high in patients with hypotension, severe head injury, or spinal cord injuries. Approximately half of these abdominal injuries can be managed nonoperatively. The diagnostic challenge is to identify abdominal injuries efficiently and accurately. Physical examination alone may result in a significant number of missed abdominal injuries, with 10% of patients with no abdominal tenderness or abdominal wall bruising having an abdominal injury on CT scan. Complicating the evaluation of patients with blunt abdominal trauma is the presence of EtOH. However, one large study has found that the presence of EtOH (levels equivalent to legal intoxication) does not appear to affect the reliability of an abdominal exam until the EtOH causes obtundation (GCS <11). There are surrogate markers for abdominal injury in the absence of physical findings, such as chest injury and hematuria. The absence of abdominal tenderness and these two injuries has a negative predictive value for abdominal injury of >99%.


CT Indications Ultrasound Indications

• Spinal cord injury, GCS < 9
• Significant abdominal pain or tenderness
• Gross hematuria
• Non-ramus pelvic fracture
• Significant chest trauma**
• Unexplained tachycardia/hypotension (with normal ultrasound)
• Hypotension


** Significant chest trauma: The presence of any of the following: myocardial or pulmonary
contusion, multiple (>2) unilateral rib fractures, left lower (8-12) rib fracture, first or second rib fracture, scapular fracture, mediastinal hematoma.

 


1. Grieshop NA, Jacobson LE, Gomez GA, et al.: Selective Use of Computed Tomography and Diagnostic Peritoneal Lavage in Blunt Abdominal Trauma. J Trauma 1995;38:727-731.
2. Fernandez L, McKenney MG, McKenney KL, et al. Ultrasound in blunt abdominal trauma. J Trauma 1998;45:841-848.
3. Healey MA, Simons RK, Winchell RJ, et al. A Prospective Evaluation of Abdominal Ultrasound in Blunt Trauma Is It Useful? J Trauma 1996;40:875-885.
4. Livingston DH, Lavery RF, Passannante MR, et al. Admission or Observation Is Not Necessary after a Negative Abdominal Computed Tomographic Scan in Patients with Suspected Blunt Abdominal Trauma Results of a Prospective, Multiinstitutional Trial. J Trauma 1998;44:273-282.


Rev. 9/2/04

 

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