Intra-abdominal injury following blunt trauma. Identifying the high-risk patient using objective risk factors
R. C. Mackersie, A. D. Tiwary, S. R. Shackford and D. B. Hoyt
Department of Surgery, University of California, San Diego Medical Center 92103.
The initial physical examination is frequently unreliable in identifying
patients with blunt trauma at high risk for having serious intra-abdominal
injury. Intra-abdominal injury may be associated with specific injuries or
risk factors, but the usefulness of such objective clinical criteria in
predicting intra-abdominal injury has not previously been determined. The
presence or absence of each of 11 clinical indicators and their association
with serious intra-abdominal injury were analyzed in 3223 patients with
blunt trauma. Linear and logistic regressions were used to determine which
factors were significant predictors of an increased probability of
intra-abdominal injury. Arterial base deficit less than -3 mEq/L, major
chest injury, hypotension, and pelvic fractures were found to significantly
increase the chance of intra-abdominal injury. Early diagnostic evaluation
of the abdomen using diagnostic peritoneal lavage or computed tomography
should be strongly considered in patients with blunt trauma who present
with these associated factors.
