SELECTIVE USE OF COMPUTED-TOMOGRAPHY AND DIAGNOSTIC PERITONEAL-LAVAGEIN BLUNT ABDOMINAL-TRAUMA

The purpose of this study was to attempt to identify those blunt traum a patients in whom expensive diagnostic studies such as computed tomog raphy and diagnostic peritoneal lavage are unnecessary to exclude intr a-abdominal injury. The medical records of 1096 blunt trauma patients evaluated at an urban level I trauma center were reviewed. Because of the urgent need to exclude intra-abdominal hemorrhage in patients with hypotension (blood pressure < 90 mm Hg), and the difficulty in obtain ing reliable information from abdominal examination in patients with G lasgow Coma Scale scores < 11 or spinal cord injury, 140 patients meet ing these criteria were reviewed but excluded from statistical analysi s. Six groups of major associated injuries felt to be potential risk f actors for the prediction of intra-abdominal injury were analyzed in t he 956 remaining patients. Only two of these potential risk factors, n amely chest injury (p = 0.0001) and gross hematuria (p = 0.0003) attai ned statistical significance. All of the 44 significant intra-abdomina l injuries occurred in the group of 253 patients that had either an ab normal abdominal examination, one of the statistically significant ris k factors, or both, for a sensitivity of 100%. Of the 703 patients wit h a normal abdominal examination and no risk factors, none had a signi ficant abdominal injury, for a negative predictive value of 100%. This study suggests that patients with either an abnormal abdominal examin ation or one of the two statistically derived risk factors require adj unctive diagnostic evaluation with diagnostic peritoneal lavage or com puted tomography scan to exclude intra-abdominal injury. Conversely, t he incidence of significant intra-abdominal injury in patients with bo th a normal abdominal examination and no risk factors is negligible an d this group, which accounted for 65% of all blunt trauma patients, ma y not require adjunctive diagnostic tests.