Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

Abstract

Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

A critical look at the value of clinical examination in polytraumatized patients

“…Traumatic injuries of the heart, aorta or abdominal organs are poorly detectable be clinical examination [22,24,27]. Only CT brings a safe diagnosis that forms the basis for causal surgical or interventional therapy [28][29].…”

“…Of 237 patients who have all met low-risk criteria (no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury), no patient has shown an intra-abdominal injury or has died [26]. Moura et al (2017) evaluated five signs for abdominal injury which are hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions. Two of 2031 patients with all clinical symptoms and examinations negative showed an intra-abdominal lesion.…”

“…Sonography identified 71 of 75 patients with intra-abdominal lesions. When all clinical criteria and ultrasound are negative, the risk for intra-abdominal lesions after blunt trauma is low [27]. But a negative CT scan finding in asymptomatic patients with blunt abdominal trauma can safely rule out an intraabdominal injury [28].…”

Solid Organs Injuries in Blunt Abdominal Trauma Patients

“…Blunt trauma can affect any intra-abdominal organ, and the injuries may not always be apparent clinically. Prompt and accurate diagnosis is essential in such patients (2) . Nonoperative management has been widely used in solid organs injury.…”