Determining the accuracy of base deficit in diagnosis of intra-abdominal injury in patients with blunt abdominal trauma.
BACKGROUND
Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. A multiplicity of diagnostic modalities exists to evaluate the abdomen. We sought to assess the diagnostic performance of base deficit (BD) in identifying intra-abdominal injury in patients with blunt abdominal trauma.


METHODS
A prospective, nonrandomized series of patients with blunt abdominal trauma admitted into the 2 emergency departments was investigated from September 2007 to September 2008. Arterial blood samples were analyzed. According to BD, the patients were divided into 2 groups: group 1 who had a BD of -6 or lower and group 2 who had a BD more than -6. Ultrasonography, computed tomographic scan, or laparotomy was performed to find intra-abdominal injury. Follow-up at 7 days by telephone interview was obtained on patients who were discharged.


RESULTS
A total of 400 patients were enrolled, with a mean (SD) age of 34.8 ± 17.1 years. Two hundred sixty-eight (67%) of them were male. Seventy-six (19%) of patients had a BD of -6 or lower. Sixty-eight (17%) of them showed to have intra-abdominal injury with a BD of approximately -8.7 ± 3.2, compared with patients without intra-abdominal injury, -0.4 ± 0.1. Patients with a BD of -6 or lower achieved more laparotomy and blood transfusion compared with patients with a BD more than -6. On receiver operating characteristic curve analysis, the cutoff point of -6 was obtained with sensitivity and specificity of 88.2% and 95.2% and with positive and negative predictive values of 79% and 97.5%, respectively. None of outpatients had abdominal problem in telephone follow-up.


CONCLUSIONS
These data show that the BD is an early available important indicator to identify intra-abdominal injury in patients with blunt abdominal trauma, as well as a high transfusion requirement.
Mofidi
Mani
M
Department of Emergency Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran. mofidim@iums.ac.ir
Hasani
Abbas
A
Kianmehr
Nahid
N
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult