Injuries distracting from intraabdominal injuries after blunt trauma

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Diagnostic Imaging

Background:

• Conscious patients with severe intraabdominal injuries (IAI) typically present with abdominal pain or tenderness.
• A subset of patients with IAI may have falsely negative physical examinations due to distracting extraabdominal injuries.

Purpose of the Study:

• To identify extraabdominal injuries that may lead to a false negative physical examination for severe IAI in adult blunt trauma patients.
• To evaluate the diagnostic utility of abdominal pain and tenderness in identifying IAI in the presence of other injuries.

Main Methods:

• Prospective study of 350 consecutive blunt trauma patients (GCS 15, age ≥18) at a level I trauma center.
• Abdominal computed tomography (CT) or diagnostic peritoneal lavage (DPL) performed regardless of initial abdominal exam findings.
• Patients were assessed for abdominal pain, tenderness, and extraabdominal injuries.

Main Results:

• 10 of 142 patients (7.0%) with no abdominal pain/tenderness had IAI, compared to 44 of 208 patients (21.2%) with pain/tenderness (P = .0003).
• Abdominal pain/tenderness had a sensitivity of 82% and a negative predictive value of 93% for IAI.
• All patients in the no-pain group with IAI had associated extraabdominal injuries.

Conclusions:

• The absence of abdominal pain or tenderness does not rule out intraabdominal injuries in blunt trauma patients.
• Extraabdominal injuries can mask severe intraabdominal injuries, necessitating a high index of suspicion and further diagnostic workup.
• Diagnostic imaging (CT or DPL) is crucial for evaluating blunt trauma patients, even with a seemingly benign abdominal examination.