Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography?

PURPOSE: The purpose of this study was to determine whether admission non-computed tomography (CT) criteria can exclude intra-abdominal injury in stable patients sustaining blunt abdominal trauma.

METHODS: Seven hundred fourteen hemodynamically stable patients with suspicion of blunt abdominal trauma were included in the study. Admission data for clinical examination, sonography, routine laboratory studies, chest/pelvic radiographic findings, and Glasgow Coma Scale (GCS) score were recorded. Each patient underwent helical abdominal CT. Injuries were considered major if they required surgery or angiographic intervention. At the authors' institution, angiography is routinely performed if there is a splenic injury of American Association for the Surgery of Trauma grade II or higher or a liver injury of American Association for the Surgery of Trauma grade III or higher. Statistical analysis was performed to determine the value of isolated and combined clinical, radiologic, and laboratory parameters in depicting an intra-abdominal injury with regard to CT results and clinical follow-up.

RESULTS: The best combination of criteria to identify a major abdominal injury was obtained when sonography, chest radiography, and three laboratory parameters (serum glutamic oxaloacetic transaminase, white blood cell count, and hematocrit) were normal: 22% (129 of 589) of patients without major injuries fulfilled these criteria. The only combination of criteria that completely excluded intra-abdominal injury was obtained when clinical criteria combined with a Glasgow Coma Scale score > 13, bedside radiologic studies, and laboratory data were all normal, but only 12% (68 of 578) of patients without abdominal injury fulfilled these criteria.

CONCLUSION: After blunt abdominal trauma, admission non-CT criteria can at best identify 12% of patients without intra-abdominal injuries and 22% of patients without major injuries.