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Blunt Abdominal Trauma: Decision Making

You can only stomach so much. Whether it’s a kick, punch, baseball bat, cricket bat, hammer, fall or car crash, there are big decisions to make in the emergency management of blunt trauma. Here are 3 scenarios designed to find out whether you know when to send your patient straight to the OT, to the scanner or to hold FAST and watch and wait…

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Featured

  PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm

Identifies children at very low risk of clinically important blunt abdominal injuries.

 Acute Blunt Abdominal Trauma

Official guideline from the American College of Emergency Physicians.

 Blunt Abdominal Trauma

The specific injuries to be concerned with after blunt abdominal trauma can be broken down into several categories: solid organ (liver and spleen), hollow viscus, mesenteric, vascular (inferior vena cava and aorta), diaphragmatic, and retroperitoneal (renal, bladder, pelvic fractures, and vascular). Other less common injuries are gallbladder, pancreas, and rectus sheath hematomas.

Articles of Interest

Blunt Abdominal Trauma and the FAST Exam

Your ED happens to have an ultrasound (US) machine. Since you have been trained in emergency sonography by the masters, you quickly fire it up. A 4-view FAST scan of the patient demonstrates 2 findings. First, there appears to be an obvious 1.5 centimeter anechoic fluid stripe at Morison’s pouch. Secondly, the patient has a viable 9-10 week IUP.

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.

Blunt Abdominal Trauma: What's the injury?

Diaphragmatic rupture with herniation of the abdominal contents into the thoracic cavity.

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.

CT in Abdominal Trauma

The sensitivity and specificity of CT in blunt abdominal injury is 96 to 100% and 94 to 100%, respectively. CT is also increasingly used for penetrating trauma, which traditionally was evaluated operatively, but the CT-results should be interpreted with caution as the sensitivity and specificity in penetrating abdominal injury is lower than for blunt trauma (31.3% to 100% and 81 to 84%, respectively).

Handlebar Injuries

An estimated 10% of bicycle injuries are related to contact with handlebars. Hemodynamically unstable patients should raise consideration for injury to the IVC or other abdominal vascular structures.

Low Risk for Intra Abdominal Trauma

Is there a way to help define a group of kids who are at Low Risk for Intra Abdominal Trauma?

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.

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

Hollow viscus injury following blunt abdominal trauma is an infrequent diagnosis. Blunt hollow viscus and mesenteric injury (HVMI) is not only an uncommon finding but its timely diagnosis is also difficult. Due to its less frequency, this injury has not been studied in detail prospectively.