Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound.

Flávia Helena Barbosa Moura,Thiara Mattos,Cristiano Below,Giovanna Zucchini Rondini,José Gustavo Parreira,Silvia Cristine Soldá,José Cesar Assef,Jacqueline Arantes G Perlingeiro

doi:10.1590/0100-69912017006015

Abstract

to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

Highlights

In Brazil, in 2015, more than 152,000 people lost their lives due to external causes[1]
We performed a retrospective analysis of information at the data bank of the Emergency Department, that were prospectively collected using standardized protocols of quality control, from 2008 to 2010
Severity of trauma and lesions were stratified by the following scores: Coma Glasgow Scale (CGS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS) and Injury Severity Score (ISS)[13]

Summary

Introduction

In Brazil, in 2015, more than 152,000 people lost their lives due to external causes[1]. This is just one of the aspects of this problem[2]. In a broad sample of victims with blunt trauma, 2% to 3% have intra-abdominal lesions (IAL)[3]. Even in asymptomatic patients with normal physical exam, it is possible to find potentially lethal intra-abdominal lesions. This is one of the reasons why we consider nondiagnosed intra-abdominal lesions a frequent cause of “preventable” death in trauma patients. Image exams had been progressively introduced in the evaluation of victims of blunt trauma

Objectives

Methods

Conclusion