EVALUATION OF THE PATIENT WITH BLUNT ABDOMINAL TRAUMA: AN EVIDENCE BASED APPROACH
Section snippets
MATERIALS AND METHODS
A MEDLINE search was conducted using the keywords abdominal trauma, diagnosis, blunt; an additional search was conducted using nonpenetrating instead of blunt after examination of the associated MeSH (Medical Search Headings) terms revealed that this search might be more comprehensive. The search was limited to English language articles and was limited to the years 1993 to 1998. This search yielded a total of 230 articles meeting the search criteria. The abstracts of these articles were then
Historical Context
Early in the history of trauma resuscitation, physical examination alone was used to assess for the presence or absence of intra-abdominal injury. This soon proved unreliable, and soon afterward four-quadrant paracentesis was added to the armamentarium of the trauma surgeon. Root et al34 described the use of DPL in 1965. It was envisioned that this “minilaparotomy” with saline lavage of the peritoneum would confirm or deny a suspicion of injury with higher accuracy, and decrease negative
FUTURE DIRECTIONS
The proper place for ultrasound scanning in the management of the trauma patient remains in question. Minimal training standards remain in question; these will become paramount in further studies in which sonograms are done by nonradiologists. The exact significance of a positive finding on ultrasound examination, and of specific sonographic signs of intraperitoneal fluid, is uncertain. How much fluid is enough to require laparotomy? Head-to-head comparison of sonography and DPL is needed to
References (42)
- et al.
Abdominal computed tomography scan as a screening tool in blunt trauma
Surgery
(1996) - et al.
Oral contrast is not necessary in the evaluation of blunt abdominal trauma by computed tomography
Am J Surg
(1993) - et al.
The diagnosis impact of computed tomograph in blunt abdominal trauma
Clin Radiol
(1983) - et al.
The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation
Am J Surg
(1994) CT scan in blunt abdominal trauma
Injury
(1993)- et al.
Peritoneal lavage in blunt abdominal trauma
Am J Surg
(1973) - et al.
Effect of oral contrast administration for abdominal computed tomography in the evaluation of acute blunt trauma
Ann Emerg Med
(1997) - et al.
Computed tomography-assisted management of splenic trauma
Am J Surg
(1997) - et al.
Abdominal ultrasound as a reliable indicator for conclusive laparotomy in blunt abdominal trauma
J Trauma
(1993) - et al.
Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma
J Trauma
(1996)
A prospective study of emergent abdominal sonography after blunt trauma
J Trauma
Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma
J Trauma
Blunt bowel and mesenteric injury: Diagnostic performance of CT signs
J Comput Assist Tomogr
Abdominal injuries without hemoperitoneum: A potential limitation of focused abdominal sonography for trauma (FAST)
J Trauma
American College of Emergency Medicine, American Academy of Neurology, American Association of Neurological Surgeons, et al: Practice parameter: Neuroimaging in the emergency patient presenting with a seizure (Summary Statement)
Ann Emerg Med
Abdominal trauma, including indications for celiotomy
A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma
J Trauma
Blunt splenic injury in adults: Clinical and CT criteria for management, with emphasis on active extravasation
Radiology
Computed tomography in blunt abdominal trauma
Arch Surg
Ultrasonography in blunt abdominal trauma: Influence of investigators' experience
J Trauma
Ultrasonography in the management of blunt abdominal and thoracic trauma
Arch Surg
Cited by (34)
Determining the accuracy of base deficit in diagnosis of intra-abdominal injury in patients with blunt abdominal trauma
2010, American Journal of Emergency MedicineCitation Excerpt :The latter is due to the fact that ultrasonography is not likely to detect most retroperitoneal or pelvic injuries [27]. However, ultrasonography has a positive predictive value of approximately 100% and nearly equal negative predictive value with BD for detecting free fluid [28]. Finally, BD correlates well with blood transfusion and laparotomy requirements (68.4% of patients with BD ≤−6 indicated for blood transfusion compared with only 1.2% of patients with BD >−6, and 57.9% of patients with BD ≤−6 indicated for laparotomy compared with only 1.2% of patients with BD >−6).
Pediatric Emergencies
2009, A Practice of Anesthesia for Infants and ChildrenPediatric emergencies
2008, A Practice of Anesthesia for Infants and Children: Expert ConsultBlunt abdominal trauma: Back to clinical judgement in the era of modern technology
2008, International Journal of SurgeryMedical imaging in the management of abdominal trauma
2006, Journal de Chirurgie
Address reprint requests to Thomas A. Amoroso, MD, Division of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
- *
Division of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts