title: Predictors of "occult" intra-abdominal injuries in blunt trauma patients.
abstract: OBJECTIVE
  to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination.
  
  
  METHODS
  We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method.
  
  
  RESULTS
  A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05) lower mean AIS score for the head segment (1.0 ± 1.4 vs. 1.8 ± 1.9), as well as higher mean AIS thorax score (1.6 ± 1.7 vs. 0.9 ± 1.5) and ISS (25.7 ± 14.5 vs. 17,1 ± 13,1). The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3%) and in motorcyclists (36.0%) (p<0.001). The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64), presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14), run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85).
  
  
  CONCLUSIONS
  Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.
authors.affiliation: Departamento de Cirurgia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: José Gustavo
authors.initials: JG
authors.lastname: Parreira
authors.affiliation: Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Juliano Mangini Dias
authors.initials: JM
authors.lastname: Malpaga
authors.affiliation: Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Camilla Bilac
authors.initials: CB
authors.lastname: Olliari
authors.affiliation: Departamento de Cirurgia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Jacqueline A G
authors.initials: JA
authors.lastname: Perlingeiro
authors.affiliation: Departamento de Cirurgia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Soldá
authors.affiliation: Departamento de Cirurgia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: José Cesar
authors.initials: JC
authors.lastname: Assef
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis*; D006801:Humans; D012189:Retrospective Studies; D013898:Thoracic Injuries; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*