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Emergent extra-abdominal trauma surgery: is abdominal screening necessary?
R P Gonzalez1, K Dziurzynski, M Maunu
1University of South Alabama Medical Center, Department of Surgery, Mobile, Alabama 36617-2293, USA.
The Journal of Trauma
|August 30, 2000
Summary
For awake blunt trauma patients needing surgery, a physical exam is enough to rule out abdominal injuries. Additional screening tests like CT scans or diagnostic peritoneal lavage do not improve outcomes.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Diagnostic Imaging
Background:
- Blunt trauma patients requiring emergent surgery often undergo abdominal screening.
- The necessity of advanced imaging beyond physical examination is debated.
Purpose of the Study:
- To determine if abdominal screening beyond physical examination is necessary for awake and alert blunt trauma patients undergoing emergent extra-abdominal surgery.
Main Methods:
- Retrospective review of 210 blunt trauma patients (GCS ≥ 14) at a Level I trauma center.
- Patients underwent emergent extra-abdominal surgery with negative abdominal exams.
- Abdominal evaluation included physical exam, CT scan, or diagnostic peritoneal lavage.
Main Results:
- Only 1.4% of patients had surgically significant intra-abdominal injuries (grade 1 liver, diaphragmatic).
- Advanced imaging and diagnostic peritoneal lavage were performed in 74% and 26% of patients, respectively.
- No difference in patient outcomes was observed with additional screening.
Conclusions:
- Physical examination alone is sufficient for abdominal assessment in awake, alert blunt trauma patients needing emergent extra-abdominal surgery.
- Additional screening modalities do not alter patient outcomes.