THE VALUE OF PHYSICAL-EXAMINATION IN THE DIAGNOSIS OF PATIENTS WITH BLUNT ABDOMINAL-TRAUMA - A RETROSPECTIVE STUDY

Between 1 January 1993 and 1 January 1994, 204 consecutive patients wi th possible blunt abdominal injury were analysed retrospectively. All patients underwent a standardized diagnostic approach on admission to the emergency room. Abdominal ultrasound (AUS) was performed in all ca ses. If there was evidence of intra-abdominal injury on physical exami nation or AUS, without signs of persistent hypovolaemia after initial assessment, contrast-enhanced computed tomographic scanning (CECT) of the abdomen was carried out without exception. Physical examination wa s equivocal in 13 and 3 per cent, respectively, of patients with 'isol ated' abdominal trauma (N = 23) or with fractures of lower ribs 7-12 a s a sole diagnosis (N=30). In multiple injury patients (N = 95) or tho se with suspected 'isolated' head injury (N = 56), these figures reach ed 45 and 84 per cent, respectively. AUS (N = 204) revealed intra-abdo minal injury in 20 per cent of patients, and CECT (N = 43) resulted in additional information in 49 per cent. Patients with 'isolated' head injury showed 9 per cent abnormalities on abdominal evaluation versus 32 per cent in multiple injury patients. In lower rib fractures (7-12) in multiple injury patients abdominal injury was diagnosed in 67 per cent of the cases. We conclude that: (I) negative findings following r eliable physical examination of patients with 'isolated' head injury s how very high values (NPV 100 per cent), but reliable physical examina tion is very infrequent (16 per cent); (2) NPV in lower rib fractures due to low energy impact is very high (100 per cent), with a reliable physical examination in most patients (97 per cent); (3) in patients w ith isolated abdominal trauma 87 per cent have a reliable physical exa mination with a moderately high NPV (71 per cent); (4) almost half the multiple injury patients have an unequivocal physical examination (45 per cent), with a high NPV following reliable physical examination fo r abdominal injury (85 per cent); (5) abdominal ultrasonography should be the first step in the radiological assessment of all patients with possible blunt abdominal injury; (6) in multiply injured patients wit h fractures of their lower ribs (7-12) due to high energy impact the i ncidence of abdominal injury is very high and CECT might be indicated even in the case of normal AUS findings. (C) 2997 Elsevier Science Ltd .