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Abstract
Between 1 January 1993 and 1 January 1994, 204 consecutive patients with 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 cases. If there was evidence of intra-abdominal injury on physical
examination or AUS, without signs of persistent hypovolaemia after initial assessment,
contrastenhanced computed tomographic scanning (CECT) of the abdomen was carried out
without exception. Physical examination was equivocal in 13 and 3 per cent, respectively,
of patients with ‘isolated’ abdominal trauma (N = 23) or with fractures of lower ribs
7–12 as a sole diagnosis (N = 30). In multiple injury patients (N = 95) or those with
suspected ‘isolated’ head injury (N = 56), these figures reached 45 and 84 per cent,
respectively. AUS (N = 204) revealed intra-abdominal 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: (1) negative findings following reliable physical examination of patients with
‘isolated’ head injury show very high values (NPV 100 per cent), but reliable physical
examination 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 with isolated abdominal trauma 87
per cent have a reliable physical examination 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 for 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 with fractures of their lower ribs (7–12) due to high
energy impact the incidence of abdominal injury is very high and CECT might be indicated
even in the case of normal AUS findings.
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Article info
Publication history
Accepted:
January 30,
1997
Identification
Copyright
© 1997 Published by Elsevier Inc.