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Found down trauma patients rarely have abdominal injuries. Imaging like CT AP and FAST scans did not change treatment, suggesting focus should be on head/neck trauma or medical conditions.

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Found down patients present a diagnostic challenge in the emergency department.
  • These patients are typically at higher risk for head and neck injuries than abdominal or pelvic trauma.
  • The utility of abdominal imaging in this population is often questioned.

Purpose of the Study:

  • To determine the incidence of abdominal injuries in found down trauma patients.
  • To evaluate the diagnostic value of emergency department imaging for abdominal injuries in this cohort.
  • To assess the impact of imaging on treatment decisions and patient outcomes.

Main Methods:

  • A 10-year trauma registry review (ending December 2013) identified found down patients.
  • Data abstracted included demographics, CT abdomen/pelvis (AP), Focused Assessment with Sonography for Trauma (FAST) scans, and documented injuries.
  • Significant abdominal/pelvic injury was defined as Abbreviated Injury Scale (AIS) ≥ 3 or operative intervention; mortality due to abdominal injury was a secondary outcome.

Main Results:

  • Of 342 patients, 60% tested positive for alcohol intoxication.
  • Abdominal imaging (CT AP, FAST, or both) did not alter patient management.
  • No patient sustained an abdominal/pelvic AIS ≥ 3; overall mortality was 10%, primarily due to head trauma or medical conditions.

Conclusions:

  • Abdominal injuries are infrequent in found down trauma patients, despite high overall mortality.
  • Current imaging modalities (CT AP, FAST) have limited value in identifying significant abdominal pathology in this group.
  • Clinical focus should prioritize the rapid diagnosis and management of non-abdominal injuries, particularly head/neck trauma and medical emergencies like stroke or sepsis.