Early definitive abdominal evaluation in the triage of unconscious normotensive blunt trauma patients.
The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in controversy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients, a retrospective analysis of 290 patients with Glasgow Coma Scale (GCS) scores < or = 8 and systolic blood pressures (SBP) > 90 mm Hg was undertaken. The hypothesis of this study was that life-threatening abdominal injury frequently occurs in these patients and injuries cannot be consistently identified from vital signs alone. Data were analyzed for injury mechanism, SBP, heart rate (HR), Injury Severity Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale score for the abdomen and brain (A-AIS, CNS-AIS), and the need for emergent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p < 0.001). Although severe abdominal injuries (A-AIS > or = 3) were frequently identified based on SBP and HR, the use of clinical signs alone resulted in more missed injuries than did using the results diagnostic peritoneal lavage (DPL). This study suggests that all unconscious normotensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.
Prall
J A
JA
Department of Surgery, Denver General Hospital, Colorado.
Nichols
J S
JS
Brennan
R
R
Moore
E E
EE
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D001794:Blood Pressure; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D014218:Triage; D014474:Unconsciousness / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis*