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PubMed1999

Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury.

BACKGROUND: Although the routine use of FAST (focused assessment with sonography for trauma) in the evaluation of trauma victims is increasing, to our knowledge, a prospective comparison of contemporary adult trauma victims managed with and without FAST has not been reported in North America. METHODS: Adult victims of blunt trauma for whom there was a suspicion of abdominal injury were managed with one of two diagnostic algorithms, FAST or no-FAST. The two algorithms were compared for diagnostic accuracy, cost, time, and delayed diagnoses. RESULTS: Among 706 patients (mean Injury Severity Score, 23), 460 were managed with FAST and 246 with no-FAST. The two groups were similar with respect to age, Injury Severity Score, prehospital time, and mortality (p = not significant). There were 3 of 460 (0.7%) delayed diagnoses in the FAST group and 4 of 246 (1.6%) in the no-FAST group (p = not significant). The diagnostic accuracy for the FAST and no-FAST algorithms was 99% and 98%, respectfully. The FAST and no-FAST algorithms led to similar rates of laparotomy, 13% and 14%, respectfully, but nonoperative management was more common in the no-FAST group (p < 0.01). The mean diagnostic cost for the FAST algorithm was $156, compared with $540 with the no-FAST algorithm (p < 0.0001) and the mean time required for diagnostic work-up was 53 minutes with the FAST algorithm, compared with 151 minutes with the no-FAST algorithm (p < 0.0001). CONCLUSION: This study has provided prospective evidence that a FAST-based algorithm for blunt abdominal injury was more rapid, less expensive, and as accurate as an algorithm that used computed tomography or diagnostic peritoneal lavage only. Trauma centers are encouraged to incorporate a FAST-based algorithm into their initial management of blunt trauma victims.

Abdominal Injuries↗
PubMed2004

[Isolated rupture of the gall bladder following a blunt abdominal injury].

The study presents a rare isolated rupture of the gall bladder following a blunt abdominal injury. The diagnostics was complicated by inaccurate anamnestic data, because the patient was injured in the drunken state and could not remember it. The clinical picture was extremely nonspecific. Repetitive ultrasound examinations aided a correct clinical decision making and an adequate management. A possibility of the gall bladder perforation following blunt injuries of the abdomen must be considered mainly in younger patients with nonspecific abdominal pains. The risk increases after abuse of alcohol or after prolonged starvation.

Abdominal Injuries↗
PubMed1975

Massive right upper quadrant intra-abdominal injury requiring pancreaticoduodenectomy and partial hepatectomy.

Three cases of massive right upper quadrant abdominal injury involving liver, pancreas, and duodenum are presented. The treatment of choice for such extensive devitalizing injuries is pancreaticoduodenectomy combined with appropriate liver resection. There was no martality in this series and followup for at least 2 years shows no evidence of chronic morbidity with regard to pancreatic function. Principles of management of severe, combined injuries of organs in the upper quadrant of the abdomen are based upon rapid control of hemorrhage, repair of major vessels, pancreaticoduodenectomy when neither the head of the pancreas nor adjacent duodenum can be preserved ent-to-end inverting pancreaticojejunostomy, choledochojejunostomy and careful evaluation of the kidney and ureter.

Abdominal Injuries↗
PubMed1988

Approach to major abdominal vascular injury.

Abdominal vascular injuries account for 25% to 30% of all vascular injuries seen in urban trauma centers where penetrating wounds are the most common cause of trauma. Patients have moderate hypotension if contained hematomas are present and present in extremis with massive abdominal distension, if hemorrhage into the peritoneal cavity is occurring. Injuries occur in five areas, each containing its own vessels and techniques of exposure and vascular repair. Included are the midline supramesocolic, midline inframesocolic, lateral perirenal, lateral pelvic, and portal areas. In these areas, arterial repair is essentially always attempted, whereas ligation of major veins, if necessary, is well tolerated in many instances. Survival depends on the number and magnitude of associated vascular and visceral injuries. If an operation can be performed soon after injury, survival with most major abdominal arterial injuries ranges from 35% to 85%. When major abdominal venous injuries are considered, the survival rate ranges from 50% to 95%. Postoperative complications include thrombosis of repairs, dehiscence of suture lines, and infection. Second-look operations may be beneficial to evaluate tenuous repairs, whereas various techniques are helpful in avoiding suture line breakdowns as a result of infection.

Abdominal Injuries↗
PubMed1982

Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage.

The accuracy of initial physical examination and peritoneal lavage in detecting intra-abdominal injury was assessed in 221 consecutive blunt trauma victims. Of the patients, 121 had negative peritoneal lavages, with one false result, and 100 had positive peritoneal lavages, including six false results and two injuries not requiring surgical correction. Hemoperitoneum occurred in 32 of 71 patients with a depressed sensorium and in 29 of 54 patients with thoracic injury. Twenty-eight of 120 patients with absent bowel tones and 20 of 100 patients with abdominal guarding or rigidity had negative peritoneal lavages. Among the 150 conscious, responsive patients there was a high incidence of false-positive and false-negative abdominal findings on physical examination. Hemoperitoneum was detected in four clinically negative patients. Significant error accompanies the initial abdominal examination and clinical assessment in the blunt trauma victim. In contract, open diagnostic peritoneal lavage is a sensitive and highly accurate test for blunt intraperitoneal injury. We believe peritoneal lavage is the single best test for intra-abdominal injury and should be performed in th majority of patients with such injuries.

Abdominal Injuries↗
PubMed2003

Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions.

The objective of this study was to determine the effect of differences in subcutaneous fat depth on adult injury patterns in motor vehicle collisions. Sixty-seven consecutive adult crash subjects aged 19-65 who received computed tomography of their chest, abdomen and pelvis as part of their medical evaluation and who consented to inclusion in the Crash Injury Research Engineering Network (CIREN) study were included. Subcutaneous fat was measured just lateral to the rectus abdominus muscle in a transverse section taken through the subject at the level of L4. Women had significantly greater subcutaneous fat depth than men. Increased subcutaneous fat depth was associated with significantly decreased injury severity to the abdominal region of females. A similar trend was noted in males although it did not reach statistical significance. Our findings suggest that increased subcutaneous fat may be protective against injuries by cushioning the abdominal region against injurious forces in motor vehicle collisions.

Abbreviated Injury Scale↗
PubMed1983

Thoracic and abdominal injuries in skiers: the role of air evacuation.

The increasing popularity of skiing as a recreational sport has resulted in a greater number of major thoracic and abdominal injuries. These injuries, unlike the more common orthopedic injuries, are often life threatening. This 8-year study reviews 44 thoracic and abdominal ski injuries managed at an urban trauma center since the inception of a helicopter air evacuation program with in-flight resuscitation capabilities. Twenty-five per cent of the injured had signs of hemorrhagic shock, and nearly 60% required a major operation. The injuries were caused by high-speed collisions with stationary objects or other skiers and by falls. Three were penetrating injuries. Organs injured were: heart, lung, kidney, spleen, liver, rectum and abdominal wall, and more than half were multiple injuries. Almost half had associated orthopedic trauma. Resuscitation was initiated on helicopter arrival in these seriously injured patients (78% of helicopter-transported patients came to operation), and apparently contributed to the low mortality of 4.5%.

Abdominal Injuries↗
PubMed2000

[Prioritizing suspected diagnosis of both brain and abdominal injuries--is it a problem?].

Current guidelines for management of suspected head and abdominal injuries are based on retrospective studies like that of Wisner & al, Following a recent review in this journal by Y. Kluger & al, which was based on non-Israeli data, we decided to define the current status at our trauma center. We compare our data of 18 months of hospital admissions for acute trauma in which head CTs were done with those of 5 articles advocating specific protocols for decisions in pre-laparotomy diagnosis. In the 861 cumulated cases, compared with the 800 of Wisner & al, craniotomy was required in 15% vs 7% (p < 0.05); laparotomy was much less frequent, 2.7% vs 12.9% (p < 0.05). The chance of finding a case requiring both craniotomy and laparotomy was 1 in 300. As the clinical condition of multiple trauma involving the head and abdomen is becoming less frequent and includes diverse situations, a comprehensive algorithm might be inaccurate. Good clinical judgment of the clinician and teamwork are therefore preferable.

Abdominal Injuries↗
PubMed1990

Diagnostic peritoneal lavage: is an isolated WBC count greater than or equal to 500/mm3 predictive of intra-abdominal injury requiring celiotomy in blunt trauma patients?

A 5-year retrospective review of 3,503 diagnostic peritoneal lavage (DPL) patients was conducted, identifying 48 (13%) blunt trauma patients who had a DPL WBC count greater than or equal to 500/mm3. The mean DPL WBC count was 1,646 +/- 2,275. Twenty (42%) of these patients were observed and discharged without subsequent operation or morbidity. Laparotomy was performed on 28 (58%) patients; 17 (61%) had a negative lap, 11 (39%) had intra-abdominal injuries requiring surgical repair or drainage (54% solid organ, 27% hollow viscus, 18% diaphragmatic). There were no significant differences between the three subgroups with regards to age, injury severity, time interval between injury and DPL, or mean DPL WBC count (p greater than 0.05). The negative-lap and no-lap groups had a significantly larger number of females; one presented with PID. The positive predictive value (PPV) of an isolated lavage WBC count of greater than or equal to 500/mm3 for intra-abdominal injury was 23% (11/48). The PPVs for DPLs performed less than and greater than or equal to 3 hours or those recalculated using WBC values higher than 500/mm3 were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1997

Computed tomography and blunt abdominal injury: patient selection based on examination, haematocrit and haematuria.

The criteria for ordering abdominal CT scans in the secondary survey of stable bluntly injured patients was examined. A patient population at high risk for having intra-abdominal injury (IAI) was identified by physical examination, a fall in haematocrit, and haematuria. A total of 444 patients receiving abdominal CT scans at a large urban trauma centre were reviewed. IAI was diagnosed in 49 (11 per cent), by radiographic and/or intra-operative findings. Abdominal tenderness was present in all 17 patients who underwent surgery. The sensitivity and specificity of abdominal CT scanning was 90 per cent and 99 per cent, respectively. The abdominal exam had a sensitivity of 63 per cent and a specificity of 65 per cent. A fall in haematocrit > or = 5 was not statistically significant. The combined abdominal exam and haematuria yielded a specificity of 93 per cent with a negative predictive value (NPV) of 93 per cent. Early CT scanning of stable patients who had sustained blunt injuries is an effective screen for IAI. The benefit of a CT scan for patients without abdominal tenderness or with an isolated fall in haematocrit is questionable. Serial abdominal examinations should remain the most timely and cost-effective method for identifying IAI in stable patients. The specificity and NPV of abdominal tenderness combined with haematuria approaches that of CT.

Abdominal Injuries↗
PubMed1964

ABDOMINAL INJURIES.

Explore the source record for details and available documents.

Abdominal Injuries↗
PubMed2005

Association between the "seat belt sign" and intra-abdominal injury in children with blunt torso trauma.

OBJECTIVES: To determine the association between an abdominal "seat belt sign" (SBS) and intra-abdominal injury (IAI) in children presenting to the emergency department (ED) after blunt trauma. METHODS: The authors performed a prospective, observational study of children at risk for IAI who presented to a Level 1 trauma center following a motor vehicle collision (MVC) during a two-year period. Physical examination findings were recorded prior to abdominal imaging or surgery. The SBS was defined as an area of erythema, ecchymoses, and/or abrasions across the patient's abdominal wall resulting from a seat belt restraint. Patients were divided into two cohorts based on the presence or absence of an SBS, then further subdivided based on abdominal tenderness or pain. The authors compared patients with and without SBS, and those with and without abdominal pain or tenderness for the presence of IAI. RESULTS: Three hundred ninety children, of whom 46 (12%, 95% CI = 9% to 15%) had an SBS, were enrolled. IAIs were more common in patients with, versus without, an SBS (14/46 vs. 36/344, relative risk 2.9; 95% CI = 1.7 to 5.0; p < 0.001). Patients with an SBS were more likely to have gastrointestinal injuries than those without an SBS (12/46 vs. 7/344, relative risk 12.8; 95% CI = 5.3 to 31; p = 0.001). Pancreatic injuries were also more common among patients with an SBS (3/46 vs. 1/344, relative risk 22; 95% CI = 2.4 to 211; p = 0.006). There was no difference in the prevalence of solid organ injuries between those with and without an SBS (4/46 vs. 34/344, relative risk 0.9, 95% CI = 0.3 to 2.4; p = 1.00). None of the six patients (0%, 95% CI = 0 to 39%) with an SBS, but without abdominal pain or tenderness, had IAIs. CONCLUSIONS: Patients with an SBS after an MVC are more likely to have IAIs than patients without an SBS, predominately due to a higher rate of gastrointestinal injuries. Patients with an SBS but without abdominal pain or tenderness appear to be at low risk for IAI.

Abdominal Injuries↗
PubMed1976

Observations on abdominal injuries in the Nigerian Civil War.

A retrospective study of 331 patients who sustained abdominal injuries during the Nigerian Civil War 1967-70 and were treated at Base Surgical Centres in the 3 Field Ambulance Nigerian Army is made. The most commonly injured organs are small intestine 148, caecum and colon 80, liver 69, spleen 26, stomach 28 and kidney 24. Case fatality rate is 33.8%. Factors influencing case mortality rate include type of organ injured, number of organs hit by penetrating missile, peri-operative complication. Other factors, not measurable in this study are mentioned. The few patients with injuries severally to the pancreas or the gall bladder who reached the operating table alive, all showed injuries to some other organs; these are among those with the highest mortality rates. Comparisons are made with similar studies from the Second World War 1942-45 and the Korean War 1952-53.

Abdominal Injuries↗
PubMed1983

[Ultrasound diagnosis following blunt abdominal injury in childhood].

In blunt abdominal trauma in childhood, sonography should be the primary method for diagnostic imaging. This simple and non-invasive investigation can be readily performed even in cases with severe traumatic organ lesions. In cases not requiring immediate surgery the method can be used for monitoring and follow-up. Other diagnostic procedures such as IVP, CT, abdominal plain x-ray, angiography, scintigraphy do not become superfluous but should be used according to the clinical and sonographic findings.

Abdominal Injuries↗
PubMed1997

[Closed abdominal injuries].

The treatment of blunt abdominal traumas remains controversial because of the difficult diagnosis; the authors review the international literature and express their five years (1990/1994) experience, constituted of sixty three patients, explaining the motivations of their diagnostic and therapeutic behaviours and the problems they met and how they succeed in resolving them. The authors remark the best way to face blunt abdominal trauma. Only the coordination among all the emergency care team involved can solve the problems.

Abdominal Injuries↗