Acute Blunt Abdominal Trauma(beta)
Official guideline from the American College of Emergency Physicians.
summary by Eric Steinberg, DO
In hemodynamically unstable patients (systolic blood pressure ≤90 mm Hg) with blunt abdominal trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy.
Clinically stable patients with isolated blunt abdominal trauma can be safely discharged after a negative result for abdominal computed tomography (CT) with intravenous (IV) contrast (with or without oral contrast).
For patients with a negative computed tomography (CT) scan result with intravenous (IV) contrast only, in whom there is high suspicion of bowel injury, further evaluation or close follow-up is indicated.
Patients with isolated abdominal trauma, for whom occult abdominal injury is being considered, are at low risk for adverse outcome and may not need abdominal computed tomography (CT) scanning if the following are absent: abdominal tenderness, hypotension, altered mental status (Glasgow Coma Scale score <14), costal margin tenderness, abnormal chest radiograph, hematocrit <30% and hematuria. Hematuria is defined variably in different studies, with the lowest threshold being greater than or equal to 25 RBCs/high-power field (HPF).