Diagnostic Evaluation of Patients with Blunt Abdominal Trauma: A Decision Analysis

Brown, Charles K.; Dunn, Kathleen; Wilson, Kenneth

doi:10.1111/j.1553-2712.2000.tb02248.x

Cited by 25 publications

(5 citation statements)

References 54 publications

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“…Clinical examination has been found to be the corner stone for primary assessment of blunt abdominal trauma patients. 9 In this study, author found abdominal distension and tenderness to be the most common positive findings in about 75% cases which was consistent with the existent literature. 10 In this study the most common grades of splenic injury were Grade II and III (According to AAST grading system on CECT abdomen) comprising 70% of the patients.…”

Section: Discussionsupporting

confidence: 90%

Outcomes in splenic injury at a high volume tertiary care centre

Nar¹,

Lubana²,

Jabbal³

et al. 2019

Int Surg J

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Background: The objective of the present study was to study the outcomes of patients following splenic injury at a tertiary care centre.Methods: This prospective study was conducted over a period of 2 years, from January 2017 to December 2018, at Dayanand Medical College and Hospital, Ludhiana to include all patients presenting to the emergency department with splenic injury diagnosed on focused abdominal sonography in trauma (FAST)/contrast enhanced computed tomography (CECT) abdomen. 60 cases were studied over this time-period. After thorough a work-up, patients were either managed conservatively or by surgical intervention. The results were recorded in a predesigned proforma and the statistics were analyzed to determine the outcome of splenic injury patients at DMCH, Ludhiana.Results: Among 10% of cases were Grade-V (American Association for Surgery in Trauma (AAST) grading), all of whom required surgical intervention. 3.3% of cases with lesser grade of injury required surgical intervention due to other reasons. 86.7% were managed conservatively. Mean length of stay was 10.9 days. 83.4% of cases were discharged in stable condition with 13.3% cases being discharged against medical advice and a mortality rate of 3.3%.Conclusions: Majority of patients (86.7%) with splenic injury can be managed conservatively. Surgical intervention is only indicated in patients with Grade-V AAST injury (10%) or in patients with concomitant injury to other organs requiring laparotomy (3.3%). In essence, early diagnosis with FAST and CECT abdomen is the cornerstone in the management of splenic injury, which can help trauma surgeons establish an early management protocol for the better outcome of patients with splenic injury. However, a study with greater sample size is required to further establish the principles of management of splenic trauma in this region.

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Section: Discussionsupporting

confidence: 90%

Outcomes in splenic injury at a high volume tertiary care centre

Nar¹,

Lubana²,

Jabbal³

et al. 2019

Int Surg J

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“…17 CECT has been used to evaluate the patients of blunt trauma abdomen and found highly specific and sensitive for diagnosing the solid organ injury, the amount of hemoperitoneum, or retroperitoneal traumatic lesions and thus predicting the management option in these patients. [18][19][20][21][22] Increasing success rates have been reported with conservative management of abdominal solid organ injuries after blunt trauma, however, most data are retrospective.…”

Section: Discussionmentioning

confidence: 99%

Parameters for therapeutic laparotomy in blunt trauma abdomen

et al. 2018

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Background: The rapid identification of potentially life threatening intra-abdominal injury is critical for patients who sustain blunt abdominal trauma. There has been a shift from operative to non-operative management (NOM) in hemodynamically stable blunt trauma abdomen patients. The aim of present study was to determine the certain clinical and radiological parameters for therapeutic laparotomy (TL) in blunt trauma abdomen in adult patients.Methods: A prospective observational study was conducted on victims of blunt trauma who presented to our level II Emergency Department from May 2012 to June 2014. Their clinical, laboratory and radiological parameters were collected, evaluated and analyzed. A previously developed ultrasound scoring system was applied to FAST findings. Patients were followed to determine if they underwent TL or NOM.Results: A total of 7750 polytrauma patients with suspected blunt trauma abdomen underwent FAST. 338 (4.36%) patients had a positive FAST, out of which 144 were included, 93 (64.58%) patients were selected for NOM, and 51 (35.4%) patients underwent TL. NOM was successful in 76 (81.73%) patients, whereas 17 (18.27%) failed NOM and were operated. Using recursive partitioning analysis, the most important predictor for a TL, was whether the patient has an ED SBP of ≤90mmHg while other parameters include, ED pulse rate >110/min; total fast score >3; large amount of hemoperitoneum; presence of abdominal guarding, pallor and polytrauma.Conclusions: There are certain immediately available clinical, and radiological parameters, which if validated by a prospective, large sample size study could help in deriving a decision rule or even a scoring system that would determine the need for therapeutic laparotomy in blunt trauma abdomen patients.

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“…Important factors include information regarding fatalities at the scene, vehicle type and velocity and steering wheel deformity, etc [13]. Physical examination: While some studies cite physical examination as only 55-65% sensitive for BAT, it is still the cornerstone for primary assessment [14]. Injuries involving the respiratory or CVS may take precedence over an abdominal injury [15].…”

Section: Blunt Abdominal Trauma (Bat)mentioning

confidence: 99%