Is it safe to discharge blunt abdominal trauma patients with normal initial findings?
BACKGROUND
Trauma is the leading health concern among young adults. Blunt abdominal trauma (BAT) is the most common type of blunt traumas. BAT patients may prove normal in the initial clinical assessments, but since the time required for an intra-abdominal injury to be clinically apparent is not predictable, deciding when to safely discharge these patients could be a dilemma. The purpose of this study is to determine whether follow-up of the early discharged or further diagnostic assessment of the later discharged BAT patients with normal initial findings reveals any abnormal findings.


METHODS
Totally, 389 hemodynamically-stable patients suspected of BAT who arrived at the emergency department (ED) of two university hospitals in Tehran from September 2013 to September 2014 were included in this study. Upon arrival at the ED, all subjects underwent abdominal examination and FAST, and were assessed for hematocrit and base deficit levels and presence of hematuria. These assessments were repeated in the patients who were discharged after 6 h, at 6 or 12 h post-arrival. All patients were followed-up after 24 h and one week by phone call.


RESULTS
Out of all study participants, 158 patients (40.6%) had normal findings in all initial assessments. These patients were discharged from the ED after a median of 5 h. After one week of follow-up, none of them had any symptom or complication, or had sought medical attention after being discharged from the study hospitals. Out of these patients, 78 patients (49.4%) were discharged after 6 hours by their physician's decision, and underwent the same diagnostic assessments for the second or third time. None of these assessments revealed any abnormal findings.


CONCLUSIONS
A combination of normal abdominal exam, normal FAST, normal hematocrit, normal base deficit, and absence of hematuria rules out intra-abdominal injury in BAT patients. It is safe to discharge patients after they prove normal for these assessments. Longer observation and repeated diagnostic assessment of these patients does not yield any new findings, and seems to be unnecessary.
a Department of Emergency Medicine , Firouzgar Hospital, Iran University of Medical Sciences , Tehran , Iran.
Mojtaba
M
Chardoli
b Department of Emergency Medicine , Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran.
Samina
S
Rezvani
c Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences , Tehran , Iran.
Pejman
P
Mansouri
d Department of Emergency Medicine , Boali Hospital, Qazvin University of Medical Sciences , Qazvin , Iran.
Kaveh
K
Naderi
b Department of Emergency Medicine , Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran.
Ali
A
Vafaei
c Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences , Tehran , Iran.
MirHojjat
M
Khorasanizadeh
c Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences , Tehran , Iran.
Vafa
V
Rahimi-Movaghar
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D061214:Patient Safety; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
Blunt abdominal trauma; discharge; intra-abdominal injury; observation; rule out