Physical examination is a poor screening test for abdominal-pelvic injury in adult blunt trauma patients.
BACKGROUND
To determine if physical examination can reliably detect or exclude abdominal or pelvic injury in adult trauma activation patients.


METHODS
Trauma registry and medical record data were retrospectively reviewed for all adult blunt trauma patients with Glasgow coma scale score>8, from 6/30/05 to 12/31/06. Attending surgeons' dictated admission history and physical examination reports were individually reviewed. Patients' subjective reports of abdominal pain were recorded as present or absent. Exam findings of the lower ribs, abdomen, and pelvis were each separately recorded as positive or negative, and were compared with findings on a subsequent objective evaluation of the abdomen (OEA). "Clinically significant" injuries were defined as those that would change patient management.


RESULTS
One thousand six hundred sixty-three patients were studied. Of patients with a negative abdominal exam, 10% had a positive OEA. When abdominal pain was absent, and exam of the lower ribs, abdomen, and pelvis was normal, OEA was positive in 7.6%, and 5.7% had a clinically significant injury. While a positive abdominal exam was predictive of a positive OEA (P<0.01), a negative exam, even when broadened (pain, lower ribs, abdomen, pelvis) did not exclude significant injuries.


CONCLUSIONS
Ten percent of trauma activation patients with a negative abdominal exam have occult abdominal/pelvic injuries. Even when exam of the lower ribs, abdomen, and pelvis are all negative and abdominal pain is absent, 5.7% have occult injuries that would change management. OEA should be used liberally for adult blunt trauma activation patients regardless of physical exam findings, to avoid missing clinically significant injuries.
Inova Fairfax Hospital, Inova Regional Trauma Center, Falls Church, Virginia 22042, USA. christopher.michetti@inova.org
Christopher P
CP
Michetti
Joseph V
JV
Sakran
Jurek G
JG
Grabowski
Earl V
EV
Thompson
Kristen
K
Bennett
Samir M
SM
Fakhry
D000007:Abdominal Injuries / Q000175:diagnosis*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010808:Physical Examination; D012189:Retrospective Studies; D014193:Trauma Centers