Open AccessClinical Predictors of Intra‐Abdominal Injury in Severe Blunt Trauma Patient
Author(s) -
Goh PL,
Schull MJ
Publication year - 2009
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/102490790901600203
Subject(s) - medicine , blunt , injury severity score , blunt trauma , multivariate analysis , pelvic fracture , focused assessment with sonography for trauma , univariate analysis , abdominal trauma , revised trauma score , pelvis , surgery , radiology , poison control , emergency medicine , injury prevention
The early recognition of intra‐abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied. Identification of such risk factors will help to prioritize patients in need for further evaluation of possible IAI. Methods A retrospective chart review was conducted of all 622 adult severe blunt trauma patients (Injury Severity Score [ISS] >12) presenting to a level 1 trauma centre in 2004. Various clinical predictors of IAI were analyzed statistically with univariate and multivariate analysis using SAS software. Results In multivariate analysis, four significant predictors of IAI were found: positive focused assessment with sonography for trauma (FAST) (OR=48.5, p<0.0001), presence of pelvic fracture (OR=2.4, p=0.0002), chest tube insertion (OR=1.8, p=0.0211), and systolic blood pressure (SBP), where every 10 mmHg decrease indicates a 14% increase in risk (OR=0.986, p=0.001). The absence of all four predictors predicted the absence of IAI with a specificity of 0.776 (95% CI 0.741 to 0.808) and a LR of 2.7 (95% CI 2.0 to 3.5). Conclusion This study suggests that positive FAST, presence of pelvic fracture, chest tube insertion, and SBP are significant predictors of IAI in adult blunt trauma patients with ISS > 12. The absence of all four predictors is associated with a reduced risk of IAI.