title: Is definitive abdominal evaluation required in blunt trauma victims undergoing urgent extra-abdominal surgery?
abstract: OBJECTIVE
  To evaluate the utility of routine abdominal computed tomographic (CT) scanning for abdominal evaluation of blunt trauma patients before urgent extra-abdominal surgery.
  
  
  METHODS
  In this observational cohort study, we prospectively enrolled all blunt trauma patients at least 8 years of age presenting to the emergency department of a Level 1 trauma center who were initially considered to require urgent extra-abdominal surgery within 24 hours of presentation. Patients were excluded if they had any of the following: 1) isolated extremity trauma, 2) signs or symptoms of intra-abdominal injury (including systolic blood pressure < 90 mm Hg; abdominal, flank, or costal margin tenderness; abdominal wall contusion or abrasion; pelvic fracture; and gross hematuria), or 3) unreliable findings on abdominal examination (Glasgow Coma Scale score < 14, paralysis, or mental retardation). Clinical data were documented on a data sheet before abdominal CT scanning.
  
  
  RESULTS
  A total of 254 patients, with a mean (+/-SD) age of 32.3 (+/-16.1) years, were enrolled. A total of 201 patients ultimately underwent urgent extra-abdominal surgery for the following procedures: orthopedic, 182 (91%); facial, 17 (8%); laceration, 7 (3%); vascular, 6 (2%); neurosurgical, 3 (1%); urology, 2 (1%); and ophthalmology, 1 (0.4%). Three patients (1.2%; 95% confidence interval = 0.2% to 3.4%) were found to have intra-abdominal injuries. Two patients had splenic injuries that required only observation. One patient (0.4%; 95% confidence interval = 0% to 2.2%) underwent laparotomy. This patient sustained multiple injuries in a motorcycle crash, including splenic, kidney, and pancreatic injuries, and underwent a splenectomy.
  
  
  CONCLUSIONS
  Abdominal CT scanning has a low yield in trauma patients whose sole indication for diagnostic abdominal evaluation is the need for general anesthesia for urgent extra-abdominal surgery. A small percentage of these patients, however, will have important intra-abdominal injuries such that further refinement of the recommendations for diagnostic study in this select population is needed.
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Bobbie Ann
authors.initials: BA
authors.lastname: Schauer
authors.forename: Hien
authors.initials: H
authors.lastname: Nguyen
authors.forename: David H
authors.initials: DH
authors.lastname: Wisner
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*