Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury.
Setting priorities in the management of patients with suspected injuries to both the head and the abdomen is difficult and depends on the likelihood of different injuries. Eight hundred trauma patients were retrospectively reviewed to determine the likelihood of a surgically correctable cerebral injury. All 800 patients, at the time of initial evaluation, were thought to have potentially correctable injuries to both the head and the abdomen. Of these, 52 had a head injury requiring craniotomy; 40 required a therapeutic celiotomy. Only three patients required both craniotomy and therapeutic celiotomy. There were more cases of delay in therapeutic celiotomy because of negative results of computed tomographic (CT) scanning of the head (13 cases) than there were delays in craniotomy because of nontherapeutic celiotomy (four cases). Need for craniotomy, based on emergency department evaluation, was indicated by the presence of lateralizing neurologic signs. Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy.


CONCLUSIONS
Patients with surgically correctable injuries of both the head and the abdomen are rare. In stable patients with altered mental status and potential injuries to both the head and the abdomen, the abdomen is best evaluated first by diagnostic paracentesis. If paracentesis does not return gross blood, CT scanning of the head should be done.(ABSTRACT TRUNCATED AT 250 WORDS)
Wisner
D H
DH
Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817.
Victor
N S
NS
Holcroft
J W
JW
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000465:Algorithms; D002985:Clinical Protocols; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D003399:Craniotomy; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D007427:Intracranial Pressure; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D009460:Neurologic Examination; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*