blunt abdominal injury

17 Jul

RAGING HYPOTHETICAL:

•Your patient is a 25 yo female s/p low mechanism MVA complaining of some mild LUQ abdominal pain. She has no rebound TTP, no guarding, no rebound. UA is negative. FAST exam is negative. What now?

Nishijima et al; “Does this Adult Patient have a Blunt Intra-abdominal Injury” JAMA April 11, 2012 Vol307, No 14

Question: What physical exam findings, lab test, diagnostic tools can accurately identify patients with intrabdominal injury

Methods: MEDLINE Search for blunt intrabdominal injuries from 1950-2012. 35 studies identified

Results: The factors that were associated with the highest intrabdominal injury were:

  • FAST exam with a positive LR 69 (38-101 CI),
  • base deficit -6; LR 18 (11-30),
  • elevated LFTs >130; LR 5.2(3.5-7.9).
  • Seat belt sign, rebound tenderness, hypotension, hematuria were also all statstically significant.
  • Interesting: leukocytosis and elevated lactate levels were not significant.

Teaching Point: FAST exam remains an excellent screening tool for intrabdominal injury when positive. However a negative FAST does not rule out intra-abdominal pathology. Other factors to consider remain LFTs, unexplained acidosis, hematuria, and a surgical abdomen on exam.

Submitted by W. Rushton.

Reference(s): Nishijima et al; “Does this Adult Patient have a Blunt Intra-abdominal Injury” JAMA April 11, 2012 Vol307, No 14; picture

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