Clinical Predictors of Intra-Abdominal Injury in Severe Blunt Trauma Patient

• Published in: Hong Kong journal of emergency medicine Vol. 16; no. 2; pp. 76 - 83
• Main Authors: Goh, PL, Schull, MJ
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.04.2009
• Subjects: Abdominal injuries; bone fractures; diagnostic imaging; multiple trauma; ultrasonography; bone fractures; ultrasonography; Abdominal injuries; diagnostic imaging; multiple trauma
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/102490790901600203

Introduction The early recognition of intra-abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied. Identification of such risk factors will help to prioritize patients in need for further evaluation of possible IAI. Methods A retrospective chart review was conducted of all 622 adult severe blunt trauma patients (Injury Severity Score [ISS] >12) presenting to a level 1 trauma centre in 2004. Various clinical predictors of IAI were analyzed statistically with univariate and multivariate analysis using SAS software. Results In multivariate analysis, four significant predictors of IAI were found: positive focused assessment with sonography for trauma (FAST) (OR=48.5, p<0.0001), presence of pelvic fracture (OR=2.4, p=0.0002), chest tube insertion (OR=1.8, p=0.0211), and systolic blood pressure (SBP), where every 10 mmHg decrease indicates a 14% increase in risk (OR=0.986, p=0.001). The absence of all four predictors predicted the absence of IAI with a specificity of 0.776 (95% CI 0.741 to 0.808) and a LR of 2.7 (95% CI 2.0 to 3.5). Conclusion This study suggests that positive FAST, presence of pelvic fracture, chest tube insertion, and SBP are significant predictors of IAI in adult blunt trauma patients with ISS > 12. The absence of all four predictors is associated with a reduced risk of IAI.