title: Abdominal Injuries in the "Found Down": Is Imaging Indicated?
abstract: BACKGROUND
  We sought to investigate the incidence of abdominal injuries in "found down" trauma patients to better understand the value of emergency department (ED) imaging. Found down patients are at high risk for injuries to the head or neck and low risk to the abdomen or pelvis, so imaging with CT of the abdomen/pelvis (AP) or Focused Assessment with Sonography for Trauma (FAST) is of questionable value.
  
  
  METHODS
  The trauma registry was queried over a 10-year period ending December 2013 for found down patients. Demographics, CT AP, FAST scans, and injuries were abstracted from the trauma registry and then through a confirmatory chart review. The primary outcome was significant abdominal or pelvis injury, defined as abdomen/pelvis Abbreviated Injury Scale (AIS) ≥ 3 or an abdominal injury that required operative intervention. The secondary outcome was mortality due to abdominal injury.
  
  
  RESULTS
  Of the 342 patients who met inclusion criteria, mean Glasgow Coma Scale (GCS) was 11.0, and 189 (60%) of those tested for alcohol were intoxicated. Abdominal imaging included: CT AP only, 88 (57%); FAST only, 37 (24%); and CT AP and FAST, 29 (19%). Neither CT AP nor FAST scan led to a change in treatment and no patient had abdomen/pelvis AIS ≥ 3. Overall mortality was 33 (10%).The 24 trauma deaths were attributed to serious head trauma (n = 16) or traumatic arrest in the ED (n = 8); the 9 medical deaths were due to cerebral vascular accident (n = 5) or sepsis (n = 4).
  
  
  CONCLUSIONS
  Although patients found down have a high mortality, abdominal injuries identified by imaging are highly unlikely. Efforts should focus on rapidly identifying and treating other causes of mortality, especially trauma to the head and neck, or medical diagnoses such as cerebral vascular accident or sepsis.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Ara
authors.initials: A
authors.lastname: Ko
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zaw
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: David M
authors.initials: DM
authors.lastname: Hoang
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Murry
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Tong
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Sogol
authors.initials: S
authors.lastname: Ashrafian
authors.affiliation: Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: McNeil
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Eric.Ley@cshs.org.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D015998:Abbreviated Injury Scale; D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D019838:Neck Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014474:Unconsciousness / Q000209:etiology*