Emergent extra-abdominal trauma surgery: is abdominal screening necessary?

Abstract

To evaluate the necessity of abdominal screening beyond physical examination in awake and alert blunt trauma patients who require emergent extra-abdominal trauma surgery. Data from an urban Level I trauma center was reviewed for all blunt trauma patients who underwent extra-abdominal emergency procedures during the period from January 1995 through August 1998. Awake and alert patients (Glasgow Coma Scale [GCS] score > or = 14) with negative abdominal physical examination results who underwent extra-abdominal emergent surgery were entered in the study. All patients entered were older than 14 years of age, hemodynamically stable, and underwent further abdominal evaluation with computed tomographic scan or diagnostic peritoneal lavage after the decision for extra-abdominal surgical intervention. Emergent surgery occurred within 8 hours of admission. Data was collected for results of diagnostic studies, hemodynamic status, mechanism of injury, indications for operative intervention, and admission blood ethanol (EtOH) levels. A total of 210 patients with an average age of 33 years (range, 14-92 years) were entered in the study. The most common mechanism of injury was motor vehicle crash (67%). Sixty-six (32%) patients presented with EtOH levels > 100 mg/dL; 181 (86%) patients presented with a GCS score of 15, and 29 (14%) presented with a GCS score of 14. The majority of surgical procedures were orthopedic (86%). Diagnostic peritoneal lavage was performed in 55 (26%) patients, and computed tomographic scans were obtained in 155 (74%) patients. Three (1.4%) intraperitoneal injuries were diagnosed in the study population. Two of the injuries were stable grade 1 liver injuries, and missed diaphragmatic injury was diagnosed on postadmission day 1. Before emergent extra-abdominal trauma surgery, abdominal evaluation with physical examination is sufficient to identify surgically significant abdominal injury in the awake and alert blunt trauma patient. Screening with additional studies does not impact patient outcome.