INCIDENCE AND SIGNIFICANCE OF FREE FLUID ON ABDOMINAL COMPUTED TOMOGRAPHIC SCAN IN BLUNT TRAUMA

Objective: To determine the incidence and significance of free fluid o n abdominal CT in blunt trauma. Design: Retrospective chart review. Me thods: All blunt trauma patients with an abdominal computed tomographi c scan from August of 1993 to December of 1995 were identified from th e trauma registry at a Level 1 trauma center, A total of 1,159 compute d tomographic scans were performed; records of 18 patients were exclud ed for incomplete records. Official reports of computed tomographic sc ans were reviewed for free fluid, solid organ injury, bladder injury, and pelvic fracture. Results: Free fluid without solid organ injury wa s found in 3% (34 of 1141). Laparotomy was performed because of free f luid in 13 patients. There were six small bowel injuries and one diaph ragm injury for a therapeutic laparotomy rate of 54%, Ten patients had trace free fluid and did not undergo laparotomy; none had a missed sm all bowel injury. Conclusions: The presence of more than trace amounts of free fluid without solid organ injury in patients with blunt traum a is a strong indication for exploratory laparotomy. Patients with iso lated trace amounts of free fluid can be safely observed.