Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound

ABSTRACT Objective: to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. Methods: retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. Results: we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. Conclusion: when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.

摘要
研究目的：针对钝性腹部创伤患者，通过临床标准及全腹超声（complete abdominal ultrasonography）检查，筛选出可排除腹腔内损伤的病例。
研究方法：对钝性创伤患者开展回顾性分析，分析的临床变量包括：血流动力学稳定性、入院时神经系统检查正常、入院时胸部体格检查正常、入院时腹部及骨盆体格检查正常，以及无分散性损伤（头颅、胸部和/或四肢的简明损伤评分（Abbreviated Injury Scale, AIS）>2）。随后，对符合上述全部临床变量的患者群体的超声检查结果进行分析。
研究结果：本研究共纳入5536例钝性创伤患者。其中144例（2.6%）检出简明损伤评分（AIS）>1的腹腔内损伤；在血流动力学稳定的患者中，该类损伤检出率为86例（2%）；在血流动力学稳定且入院时神经系统检查正常的患者中，检出率为50例（1.8%）；在血流动力学稳定、入院时神经系统及胸部体格检查均正常的患者中，检出率为39例（1.5%）；在血流动力学稳定、入院时神经系统、胸部、腹部及骨盆体格检查均正常的患者中，检出率为12例（0.5%）；在血流动力学稳定、入院时神经系统、胸部、腹部及骨盆体格检查均正常且无分散性损伤的患者中，仅2例（0.1%）检出腹腔内损伤。在符合上述全部临床变量的患者中，693例全腹超声检查结果正常，该群体中未检出任何腹腔内损伤。
研究结论：当联合应用全部临床标准与全腹超声检查时，可筛选出一组发生显著腹腔内损伤风险极低的钝性腹部创伤患者。