HWN Suggests

Abdominal Trauma: Is There Anything We Can Be Doing Better?

There is a clear trend of change in management from mandatory laparotomy to selective surgery in both penetrating and blunt abdominal trauma. Helping decide the need for laparotomy can include diagnostic modalities. A FAST exam is most helpful in penetrating abdominal trauma patients while whole body CT should be considered in stable major trauma patients with significant mechanisms. However, even a stable patient with negative imaging work-up could have underlying abdominal injury (i.e. don’t forget the diaphragm).

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 Can stable patients presenting to the emergency department with blunt abdominal trauma be managed safely without a CT scan?

When it comes to managing blunt abdominal trauma in stable patients, let your clinical exam be your guide. Patients who remain hemodynamically stable with no concerning features on physical exam can be safely managed with careful observation. POCUS is helpful in identifying intra-abdominal injury and is a great resource both as an adjunct and in the absence of a CT scanner.

Articles of Interest

Abdominal Trauma: Blunt or penetrating

Assessment of abdominal trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey.

Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

This retrospective study demonstrates a low prevalence of IAI following BAT in patients who are hemodynamically stable and have initial negative evaluations in the ED.

CT in Abdominal Trauma

Nowadays there is a trend towards non-operative management of blunt abdominal trauma. More than 50% of splenic injury, 80% of liver injury and virtually all renal injurys are managed non-operatively, because patients proved to have better outcomes on the long term related to visceral salvage.

Modern Evaluation of Abdominal Trauma

Abdominal trauma can be mysterious to some physicians. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, ultrasound and CT scans, patients can be quickly and efficiently evaluated.

Pediatric Blunt Abdominal Trauma: Recognition and Management in the Emergency Department

Children are more susceptible than adults to serious injury secondary to blunt abdominal trauma. When a pediatric patient presents to the ED following blunt abdominal trauma, the abdominal examination may be unreliable due to the child’s age or developmental level, or due to an associated head injury; a negative abdominal examination and the absence of comorbid injuries do not completely rule out an intra-abdominal injury in these patients.

To Scan or Not to Scan? CT Abdomen in Children with Blunt Torso Trauma

While blunt pediatric abdominal trauma has a high incidence, the prevalence of IAI-I is rather low.

Resources

SAEM

The bedside sonogram (US) has become standard of care when evaluating patients with BAT. Free fluid in Morrison’s pouch is concerning for hemoperitoneum, which may require emergent surgical intervention (See Figure 3). An initially negative eFAST exam, should be repeated if the clinical picture changes during evaluation.