Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma

Michael M Neeki; Dylan Hendy; Fanglong Dong; Jake Toy; Kevin Jones; Keasha Kuhnen; Ho Wang Yuen; Pamela Lux; Arnold Sin; Eugene Kwong; David Wong

doi:10.1136/tsaco-2017-000109

Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma

Trauma Surg Acute Care Open. 2017 Sep 26;2(1):e000109. doi: 10.1136/tsaco-2017-000109. eCollection 2017.

Authors

Michael M Neeki^{1

2}, Dylan Hendy¹, Fanglong Dong³, Jake Toy³, Kevin Jones¹, Keasha Kuhnen¹, Ho Wang Yuen^{1

2}, Pamela Lux^{1

2}, Arnold Sin^{1

2}, Eugene Kwong¹, David Wong^{4

5}

Affiliations

¹ Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.
² Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA.
³ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA.
⁴ Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA.
⁵ Department of Surgery, California University of Science and Medicine, Colton, California, USA.

Abstract

Background: A thorough history and physical examination in patients with blunt abdominal trauma (BAT) is important to safely exclude clinically significant intra-abdominal injury (IAI). We seek to evaluate a correlation between self-reported abdominal pain, abdominal tenderness on examination and IAI discovered on CT or during exploratory laparotomy.

Methods: This retrospective analysis assessed patients with BAT ≥13 years old who arrived to the emergency department following BAT during the 23-month study period. Upon arrival, the trauma team examined all patients. Only those who underwent an abdominal and pelvic CT scan were included. Patients were excluded if they were unable to communicate or lacked documentation, had obvious evidence of extra-abdominal distracting injuries, had a positive drug or alcohol screen, had a Glasgow Coma Scale ≤13, or had a positive pregnancy screening. The primary objective was to assess the agreement between self-reported abdominal pain and abdominal tenderness on examination and IAI noted on CT or during exploratory laparotomy.

Results: Among the 594 patients included in the final analysis, 73.1% (n=434) had no self-reported abdominal pain, 64.0% (n=384) had no abdominal tenderness on examination, and 22.2% (n=132) had positive CT findings suggestive of IAI. Among the 352 patients who had no self-reported abdominal pain and no abdominal tenderness on examination, a significant number of positive CT scan results (14%, n=50) were still recorded. Furthermore, a small but clinically significant portion of these 50 patients underwent exploratory laparotomy (1.1%, n=4). All four of these patients ultimately underwent a splenectomy and all were completed on hospital day one.

Conclusion: Lack of abdominal pain and tenderness in patients with BAT with non-distracting injuries was associated with a small portion of patients who underwent a splenectomy. Patients with BAT without abdominal pain or tenderness may need a period of observation or CT scan to rule out IAI prior to discharge home.

Level of evidence: Level III, therapeutic/care management.

Keywords: abdominal pain; abdominal tenderness; blunt abdominal trauma; intra-abdominal injury.