Is Definitive Abdominal Evaluation Required in Blunt Trauma Victims Undergoing Urgent Extra-abdominal Surgery?
Source: Academic Emergency Medicine, Volume 12, Number 8, August 2005 , pp. 707-711(5)
Abstract:: Objectives: To evaluate the utility of routine abdominal computed tomographic (CT) scanning for abdominal evaluation of blunt trauma patients before urgent extra-abdominal surgery. Methods: In this observational cohort study, we prospectively enrolled all blunt trauma patients at least 8 years of age presenting to the emergency department of a Level 1 trauma center who were initially considered to require urgent extra-abdominal surgery within 24 hours of presentation. Patients were excluded if they had any of the following: 1) isolated extremity trauma, 2) signs or symptoms of intra-abdominal injury (including systolic blood pressure <90 mm Hg; abdominal, flank, or costal margin tenderness; abdominal wall contusion or abrasion; pelvic fracture; and gross hematuria), or 3) unreliable findings on abdominal examination (Glasgow Coma Scale score <14, paralysis, or mental retardation). Clinical data were documented on a data sheet before abdominal CT scanning. Results: A total of 254 patients, with a mean (±SD) age of 32.3 (±16.1) years, were enrolled. A total of 201 patients ultimately underwent urgent extra-abdominal surgery for the following procedures: orthopedic, 182 (91%); facial, 17 (8%); laceration, 7 (3%); vascular, 6 (2%); neurosurgical, 3 (1%); urology, 2 (1%); and ophthalmology, 1 (0.4%). Three patients (1.2%; 95% confidence interval = 0.2% to 3.4%) were found to have intra-abdominal injuries. Two patients had splenic injuries that required only observation. One patient (0.4%; 95% confidence interval = 0% to 2.2%) underwent laparotomy. This patient sustained multiple injuries in a motorcycle crash, including splenic, kidney, and pancreatic injuries, and underwent a splenectomy. Conclusions: Abdominal CT scanning has a low yield in trauma patients whose sole indication for diagnostic abdominal evaluation is the need for general anesthesia for urgent extra-abdominal surgery. A small percentage of these patients, however, will have important intra-abdominal injuries such that further refinement of the recommendations for diagnostic study in this select population is needed.
Document Type: Research article
Affiliations: 1: Departments of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 2: Departments of Emergency Surgery, UC Davis School of Medicine, Sacramento, CA 3: Department of Surgery, UCSF East Bay, San Francisco, CA
Publication date: 2005-08-01