> Blunt Abdominal Trauma

Acute Blunt Abdominal Trauma

Official guideline from the American College of Emergency Physicians.

summary by Eric Steinberg, DO

Diagnosis

Imaging

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.

Level B

Oral contrast is not required in the diagnostic imaging for evaluation of blunt abdominal trauma. All of the studies reviewed included the use of intravenous (IV) contrast.

Level B

Risk Stratification

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).

Level B

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.

Level C

Further observation, close follow-up, and/or imaging may be warranted in select patients based on clinical judgment.

Level C

Clinical Predictors

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).

Level C

What do the icons mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on Class III studies, or in the absence of any adequate published literature, based on panel consensus.

Literature

Original/Primary Reference

Diercks DB, Mehrotra A, Nazarian DJ, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation of Adult Patients Presenting to the Emergency Department With Acute Blunt Abdominal Trauma. Ann Emerg Med. 2011;57(4):387-404.

Calc Function

Diagnosis