EARLY DEFINITIVE ABDOMINAL EVALUATION IN THE TRIAGE OF UNCONSCIOUS NORMOTENSIVE BLUNT TRAUMA PATIENTS

The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in contro versy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients , a retrospective analysis of 290 patients with Glasgow Coma Scale (GC S) scores less than or equal to 8 and systolic blood pressures (SBP) > 90 mm Hg was undertaken. The hypothesis of this study was that life-th reatening abdominal injury frequently occurs in these patients and inj uries cannot be consistently identified from vital signs alone. Data w ere analyzed for injury mechanism, SBP, heart rate (HR), Injury Severi ty Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale s core for the abdomen and brain (A-AIS, CNS-AIS), and the need for emer gent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p < 0.001). Although seve re abdominal injuries (A-AIS greater than or equal to 3) were frequent ly identified based on SBP and HR, the use of clinical signs alone res ulted in more missed injuries than did using the results diagnostic pe ritoneal lavage (DPL). This study suggests that all unconscious normot ensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.