Clinical and Laboratory Evaluation of Blunt Trauma Patients for the Early Diagnosis of Intra-Abdominal Injuries

Abstract

Background: Blunt abdominal trauma is seen with increasing frequency in emergency rooms and is continuous to be associated with significant morbidity and mortality. Intra-abdominal injuries following blunt trauma are of great medico-legal importance to forensic experts. Aim: The study aimed to investigate the contribution of non-invasively and rapidly obtained clinical presentation and biochemical parameters in the early diagnosis of intra- abdominal (IA) injuries in blunt trauma patients, then develop a scoring system and investigate its clinical applicability as pre-test to determine whether abdominal CT should be performed during the diagnosis or not. This may help to decrease number of malpractice claims due to medical negligence. Methods and results: A prospective study was conducted on 30 adult patients with blunt abdominal trauma presented to Emergency department (ED) of Ain shams university hospitals (ASUHS). Patients were classified into two groups: group 1: adult patients with blunt abdominal trauma with normal CT abdomen. Group 2: adult patients with blunt abdominal trauma with abnormal CT abdomen. For every patient, demographic, trauma, and clinical data were collected. Laboratory parameters measured included blood hemoglobin level, liver enzymes, kidney function tests, pancreatic enzymes and finally CT abdomen was done. The mean age for the adult patients with blunt abdominal trauma was 34 ± 11 years. Male to female ratio was 2:1 with no significant importance. There was no significant difference between both groups of the study as regards aetiology and delay time of trauma and the most common cause of BAT was motor car accidents that compromised (36.7%) of all patients. There was no significant difference between both groups of study as regards abdominal symptoms and signs. Regarding vital signs, incidence of patients with high pulse rate per minute more than 100 bpm and high respiratory rate more than 20 brpm were highly significant in group II than group I. There was no significant difference between both groups regarding blood pressure. As regards the conscious level, there was significant difference between both groups of study. Hemoglobin level was significantly lower group II than group I with cutoff point level equal to or less than 9.8gm/dl. AST, ALT, urea, creatinine, amylase and lipase levels showed no significant difference between both groups. According to CT, the spleen was the most injured organ in blunt abdominal trauma patients (43.8%) followed by the liver 4 cases (25%). Conclusion: A scoring system could be done by the sum of points obtained from each parameter (Hb level, pulse rate, respiratory rate, and conscious level). The score points range from (0-4). It was found that the patients with score (0-2) were mainly with normal CT abdomen. On the other hand, patients with score (1-4) were mainly with positive CT findings. So, this scoring system can be used for the early prediction of the presence of IAIs in BAT patients and as a pretest for the need of CT. Recommendations: Blood hemoglobin level, pulse rate, respiratory rate and conscious level can be used as early predictors of IAIs in BAT patients. A scoring system using blood hemoglobin, pulse rate, respiratory rate and conscious level can be used as a pretest probability to determine the need for abdominal CT for the detection of intra-abdominal injury.