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PubMed1983

The diagnosis of intra-abdominal injury in patients with cervical cord trauma.

A review of the records of 288 patients sustaining blunt cervical column and/or cord injuries revealed that twelve (4.2%) had significant intra-abdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP less than 100 mm Hg) with neurologic deficits were found to have intra-abdominal injuries. Shock in another 15 was the result of major associated injuries and/or the loss of sympathetic vascular tone. Thus 40 of these 58 patients (69%) had neurogenic shock. An analysis of the mechanisms of injury and associated injuries indicated that those at risk of having significant intra-abdominal injury are those who have been injured in a vehicular crash and those who have other obvious major injuries that can cause shock. The data indicate that patients not at risk of having intra-abdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.

Abdominal Injuries↗
PubMed1997

[Instrumental diagnosis for therapy decision making in abdominal injuries].

The aim of diagnostic procedures following abdominal injuries is rapid assessment of the necessity for surgical intervention and specification of the organ lesion, thus reducing the number of negative laparotomies. The extent of the diagnostic approach must be reduced in unstable patients. Sonography is the standard procedure in stable as well as in unstable patients, both in the initial period and the subsequent follow-up. CT-scan is complementary to sonography in detecting organ lesions. Sonographically guided puncture has replaced diagnostic peritoneal lavage. Laparoscopy following blunt abdominal injuries is not useful; however, it may be helpful following penetrating abdominal trauma.

Abdominal Injuries↗
PubMed2001

Biomechanics of abdominal injuries.

Although considerable efforts have been advanced to investigate the biomechanical aspects of abdominal injuries, reviews have been very limited. The purpose of this article is to present a comprehensive review of the topic. Traumatic abdominal injuries occur due to penetrating or blunt loading. However, the present review is focused on blunt trauma. Because of the complexity of the abdomen, biomechanically relevant anatomical characteristics of the various abdominal organs are presented. The proposed mechanism of injury for these organs and methods for abdominal injury quantification are described. This is followed by a detailed analysis of the biomechanical literature with particular emphasis on experiments aimed to duplicate real world injuries and attempt to quantify trauma in terms of parameters such as force, deflection, viscous criteria, pressure criteria, and correlation of these variables with the severity of abdominal injury. Experimental studies include tests using primates, pigs, rats, beagles, and human cadavers. The effects of velocity, compression, padding, and impactor characteristics on tolerance; effects of pressurization and postmortem characteristics on abdominal injury; deduction of abdominal response corridors; and force-deflection responses (of the different abdominal regions and organs) are discussed. Output of initial research is presented on the development of a device to record the biomechanical parameters in an anthropomorphic test dummy during impact. Based on these studies and the current need for abdominal protection, recommendations are given for further research.

Abdominal Injuries↗
PubMed1990

[Basic studies on abdominal injuries. Part 1: Degree of depression of abdominal wall by compression].

The degree of depression of the abdominal surface by compression was measured in 121 healthy adult male having an average age of 20.4 years. Three disks of different sizes (10, 25, and 45 mm in diameter) were attached to the edge of the baresthesiometer, and pressures of 1, 3 and 5 kg were applied to the 10 mm disk, and 1, 3, 5, and 7 kg to the other disks. The regions tested were the medial abdomen approximately 2 cm above the umbilicus and the left and right flanks at the level of umbilicus. The higher the pressure administered, the greater the depression formed on each disk. Severe pain occurred in the nonanesthetized person, and it was difficult to increase the pressure to a higher level than 7 kg. At each pressure, the smallest disk produced larger depression than did the other two. The degree of depression was related to the total pressure administered rather than to the amount of pressure per unit area. The distribution of measured value was shown to be normal. After the largest depression for each region had been determined, a pressure of 7 kg was imposed on the 25-mm disk. On the medial abdomen, the anatomical position generated a mean depression of 6.3 cm, and the spine position a depression of 5.04 cm. On the flank, mean value of the depression was approximately 5.7 cm, and did not differ between the anatomical and supine positions and between the right and left flanks.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2006

Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases.

OBJECTIVE: To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. METHODS: The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. RESULTS: In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% (181/1 206) and 79.9% (612/766) in patients with thoracic and abdominal injury (P<0.01), 5.2% (39/758) and 31.7% (142/448) in patients with blunt and penetrating chest trauma (P<0.01), and 72.45% (359/496) and 93.7% (253/270) in patients with blunt and penetrating abdominal injuries (P<0.01), respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9% (75/950) and 3.6% (21/590), respectively (P<0.01). Most patients died from exsanguination. CONCLUSIONS: The first "golden hour" after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

Abdominal Injuries↗
PubMed1991

Flexion-distraction injuries to the lumbar spine associated with abdominal injuries.

Flexion-distraction injuries to the lumbar spine frequently occur with concomitant abdominal viscus injury. We encountered 16 patients with flexion-distraction lumbar spine injuries. Half of them also suffered abdominal viscus rupture. Lap safety belts were most frequently associated with these injuries; however, the incorrect, underarm use of the shoulder harness was common in our series. The diagnosis of the spinal injury was frequently delayed when abdominal viscus injury occurred together with a flexion-distraction spinal injury. Thorough physical and radiographic examination of the spine as well as a detailed history, including seat belt use, is necessary to diagnose these injuries properly.

Abdominal Injuries↗
PubMed2002

Clinical importance of intraperitoneal fluid in patients with blunt intra-abdominal injury.

The purpose of this study was to determine the prevalence of intraperitoneal fluid (IF) in blunt trauma patients with intra-abdominal injuries, to determine the rate of exploratory laparotomy in patients with and without IF, and to identify the location of this IF. We retrospectively reviewed the records of 604 patients with intra-abdominal injuries after blunt trauma who were admitted to a level 1 trauma center over a 42-month period. Patients were considered to have intra-abdominal injuries if an injury to the spleen, liver, urinary tract, pancreas, adrenal glands, gallbladder, or gastrointestinal tract was identified on abdominal computed tomography (CT) or at exploratory laparotomy. Patients were considered to have IF if fluid was identified on abdominal CT or during exploratory laparotomy. In patients undergoing abdominal CT or abdominal ultrasound (US), the specific location of the IF was identified. Four hundred forty-three (73%, 95% confidence interval [CI] 69 - 77%) of the 604 patients with intra-abdominal injuries had IF. Patients with IF had an increased risk of laparotomy (344/443 [78%] v 44/161 [27%], odds ratio = 9.2, 95% CI 6.1-13.9). Of the 539 patients undergoing abdominal CT or abdominal US, IF was identified in 389 (72%) and was visualized in the following locations: 258 of 389 (66%) in Morison's pouch, 216 of 389 (56%) in the left upper quadrant, 187 of 389 (48%) in the pelvis, and 139 of 390 (36%) in paracolic gutters. Three patients with IF visualized solely in the paracolic gutters underwent laparotomy. The majority of patients with intra-abdominal injuries have IF, and these patients are more likely to undergo laparotomy. Morison's pouch is the most common location for IF to be detected with radiologic imaging. However, visualization of the paracolic gutters with abdominal US may detect IF in patients with intra-abdominal injuries that would otherwise not be detected by US.

Abdominal Injuries↗
PubMed2003

Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes.

BACKGROUND: Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown. METHODS: A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size. RESULTS: For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]). CONCLUSIONS: Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.

Abbreviated Injury Scale↗
PubMed2002

Identification of children with intra-abdominal injuries after blunt trauma.

STUDY OBJECTIVE: We sought to determine the utility of laboratory testing after adjusting for physical examination findings in the identification of children with intra-abdominal injuries after blunt trauma. METHODS: The study was a prospective observational series of children younger than 16 years old who sustained blunt trauma and were at risk for intra-abdominal injuries during a 2(1/2)-year period at an urban Level I trauma center. Patients were examined by faculty emergency physicians and underwent standardized laboratory testing. Clinical and laboratory findings were recorded on a standardized data sheet. Intra-abdominal injury was considered present if an injury was documented to the spleen, liver, pancreas, kidney, adrenal glands, or gastrointestinal tract. We performed multiple logistic regression and binary recursive partitioning analyses to identify which physical examination findings and laboratory variables were independently associated with intra-abdominal injury. RESULTS: Of 1,095 enrolled patients, 107 (10%, 95% confidence interval [CI] 8% to 12%) had intra-abdominal injuries. The mean age was 8.4+/-4.8 years. From both analyses, we identified 6 findings associated with intra-abdominal injury: low systolic blood pressure (adjusted odds ratio [OR] 4.1; 95% CI 1.1 to 15.2), abdominal tenderness (adjusted OR 5.8; 95% CI 3.2 to 10.4), femur fracture (adjusted OR 1.3; 95% CI 0.5 to 3.7), serum aspartate aminotransferase concentration more than 200 U/L or serum alanine aminotransferase concentration more than 125 U/L (adjusted OR 17.4; 95% CI 9.4 to 32.1), urinalysis with more than 5 RBCs per high-powered field (adjusted OR 4.8; 95% CI 2.7 to 8.4), and an initial hematocrit of less than 30% (adjusted OR 2.6; 95% CI 0.9 to 7.5). CONCLUSION: After adjusting for physical examination findings, laboratory testing contributes significantly to the identification of children with intra-abdominal injuries after blunt trauma.

Abdominal Injuries↗
PubMed1992

[Abdominal injuries in polytraumatised patients].

Authors have observed in 1978-1984 in 87 of 214 polytrauma cases injuries of the abdominal organs. The data concerning children in whom the high ratio of injuries of the abdominal organs and the low mortality are conspicuous are shown separately. The necessity of urgent diagnosis to which especially the abdominal irrigation has given great help is stressed. After a review of the literature and a control of their own material the problem is considered as actual, as in polytraumas the abdominal injuries are frequent, the valuation of the abdomen in the patient, generally in shock or unconscious is problematic, the many times simultaneous therapy of the abdominal and joined injuries is difficult, the mortality high.

Abdominal Injuries↗
PubMed2005

Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes.

STUDY OBJECTIVE: We assess the relationship between steering wheel deformity and serious thoracic or abdominal injury among drivers and front seat passengers involved in motor vehicle crashes, while adjusting for important crash factors. METHODS: This was a national population-based cohort of adults involved in motor vehicle crashes from 1995 to 2002 and included in the National Automotive Sampling System Crashworthiness Data System database. Participants were front seat occupants aged 16 years or older involved in motor vehicle crashes with collision. Outcome measure was serious thoracic or abdominal injury, defined as an Abbreviated Injury Scale score greater than or equal to 3 in these body regions. RESULTS: There were 42,860 persons involved in motor vehicle crashes and seated in the driver or front passenger seat whose data were available for analysis. Five hundred fifty-four (1.3%) persons had serious thoracic injuries, and 169 (0.4%) persons had serious abdominal injuries. In multivariable logistic regression models that adjusted for important crash factors and the National Automotive Sampling System Crashworthiness Data System sampling design, increasing steering wheel deformity was associated with serious thoracic injury in drivers (odds ratio [OR] for each 5-cm increase in steering wheel deformity 1.28, 95% confidence interval [CI] 1.04 to 1.59) and front seat passengers (OR 1.77, 95% CI 1.26 to 2.49). Increasing steering wheel deformity was associated with serious abdominal injury in front seat passengers (OR 1.45, 95% CI 1.11 to 1.89) but not in drivers (OR 0.95, 95% CI 0.79 to 1.15). CONCLUSION: Steering wheel deformity is an independent predictor of serious thoracic injury in drivers and front seat passengers and is associated with serious abdominal injury among front seat passengers. For these occupants, the risk of these injuries increases incrementally with increasing steering wheel deformity.

Abbreviated Injury Scale↗
PubMed1990

The diagnosis of abdominal injuries in comatose patients.

The clinical course of 95 comatose trauma patients was prospectively evaluated. The role of clinical findings and diagnostic peritoneal lavage (DPL) combined with computed tomography (CT) were assessed in the diagnosis of abdominal injuries. Seven per cent of the patients were comatose due to hypoperfusion, and did not have a primary brain injury. Of the remaining 88 patients, 28% had an associated abdominal injury. Hypotension predicted an associated abdominal injury with an accuracy of 72%, and a haematocrit less than 30% had an accuracy of 82%. Clinical examination was 50% accurate. DPL was 93% accurate, with a false-positive rate of 10%. No abdominal injuries were present in the group in whom the lavage results were negative, while no unnecessary laparotomies were performed in the group with a 4+ or 5+ positive DPL (calorimetric method). In the group with 1+, 2+ and 3+ positive DPL, 3/15 laparotomies (12%) were done for minor abdominal injuries. Minimising unnecessary laparotomies was achieved by utilising CT to determine the nature and extent of the injury. By using DPL as a screening test, and CT to quantify the injury, unnecessary operations can be avoided, and all injuries can still be diagnosed.

Abdominal Injuries↗
PubMed1985

Abdominal injuries in children: an analysis of 348 cases.

Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951-1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8.6 per cent mortality in the first 10 years of the period.

Abdominal Injuries↗
PubMed1978

Abdominal paracentesis for early diagnosis of closed abdominal injury.

In a 4 year material of closed abdominal injuries consisting of 114 patients, mostly multiple trauma traffic accidents, diagnostic paracentesis with peritoneal lavage was used in 47 cases. The aim of the investigation was to indicate or exclude blood in the abdominal cavity as early as possible and thereby facilitate the priority of treatment and diminish the delay in surgical intervention. The main indication was suspicion of abdominal injury in multiple traumatized, unconscious or shocked patients. The puncture was performed in the emergency room immediately after ordinary lifesaving steps had been taken. If blood was obtained the patients were sent to the operating theatre for laparotomy. If blood was not obtained one litre of an isotonic salt solution was infused and if the returning solution was only slightly blood tinged, the investigation was continued with roentgenographic methods. In our series only two cases were not correctly diagnosed. Diagnostic paracentesis is the most rapid method of demonstrating intraabdominal bleeding, which is found in 90% of all serious intraabdominal organ injuries. In doubtful cases this method must be combined with other diagnostic methods and the patient put under proper clinical observation.

Abdominal Injuries↗
PubMed1992

Hematuria as a predictor of abdominal injury after blunt trauma.

Among the 1,484 patients included in the Renal Trauma Project with evidence of blunt trauma and hematuria, 160 patients were found to have both hematuria and a significant intra-abdominal injury not related to the genitourinary system. The incidence of abdominal injury generally increased with the degree of hematuria, approaching 24% in patients with gross hematuria. For each category of degree of hematuria, patients with shock had a significantly higher incidence of abdominal injury (p < 0.05) than patients without shock. The incidence of abdominal injury in patients with microscopic hematuria and shock was 29%, and it was 65% for patients with both gross hematuria and shock. All patients with gross hematuria after blunt abdominal trauma and all patients with microscopic hematuria and a history of shock should be evaluated for both urologic and extra-renal abdominal injuries.

Abdominal Injuries↗
PubMed2004

Predictors of pediatric abdominal injury risk.

Although previous research has linked poor seat belt fit to abdominal organ injury for children, few have studied the pattern of pediatric abdominal injuries and its relationship to key characteristics beyond this primary association. In this study, data were obtained from a probability sample of 19,125 children, representing 243,540 children, under age 16 years who were enrolled in an on-going crash surveillance system which links insurance claims data to validated telephone survey and crash investigation data. The risk of AIS2+ abdominal injury was estimated for various crash, restraint, vehicle and child correlates and multivariate logistic regression was used to identify the relative importance of these predictors. Children 4-8 years of age were at the highest risk of abdominal injury: they were 24.5 times and 2.6 times more likely to sustain an AIS2+ abdominal injury than those 0-3 years and 9-15 years, respectively. The injury risk for children 4-8 years of age was 6 and 10 times higher in passenger cars and SUVs, respectively, compared to minivans. No reduction in abdominal injury risk was seen with rear seating. The role of direction of impact on injury risk varied by child age indicating diverse injury sources influenced by developmental differences and changes in restraint practices among the age groups. The data suggested a trade-off between head/face injury and abdominal injury: for those restrained in vehicle seat belts in rear seats, those with an AIS2+ head/face injury were nearly 90% less likely to sustain an abdominal injury than those without a head/face injury. These findings suggest mechanistic hypotheses to be tested with additional in-depth data.

Journal Article↗
PubMed1989

[Abdominal injuries. Occurrence and outcome].

A retrospective study of intra-abdominal injuries treated during the ten-year period 1977 to 1986, show that road traffic accidents were responsible for the injury in 38% of 221 patients. Accidents from sports and recreation were the cause in 23% of the cases. The median age was 19 years. Renal injuries were most common, followed by splenic injuries. 119 patients (54%) were operated for abdominal injury. 90 patients (41%) needed blood transfusions and 29 (13%) were treated by respirator. 95 patients had concommitant extraabdominal injuries. The overall lethality was 9%.

Abdominal Injuries↗