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Identifying the High-Risk Patient Using Objective Risk Factors

Robert C. Mackersie, MD; Anurag D. Tiwary, MD; Steven R. Shackford, MD; David B. Hoyt, MD

Arch Surg. 1989;124(7):809-813.

Abstract
• 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.

(Arch Surg. 1989;124:809-813)

Author Affiliations
From the Department of Surgery, University of California, San Diego Medical Center.

Footnotes
Accepted for publication March 4, 1989.

Read before the 96th Annual Meeting of the Western Surgical Association, San Diego, Calif, November 15, 1988.

Reprint requests to Department of Surgery H-640B, University of California, San Diego Medical Center, 225 Dickinson St, San Diego, CA 92103 (Dr Mackersie).

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