TY - JOUR
T1 - Physical Examination is a Poor Screening Test for Abdominal-Pelvic Injury in Adult Blunt Trauma Patients
AU - Michetti, Christopher P.
AU - Sakran, Joseph V.
AU - Grabowski, Jurek G.
AU - Thompson, Earl V.
AU - Bennett, Kristen
AU - Fakhry, Samir M.
PY - 2010/3
Y1 - 2010/3
N2 - Background: To determine if physical examination can reliably detect or exclude abdominal or pelvic injury in adult trauma activation patients. Methods: Trauma registry and medical record data were retrospectively reviewed for all adult blunt trauma patients with Glasgow coma scale score > 8, from 6/30/05 to 12/31/06. Attending surgeons' dictated admission history and physical examination reports were individually reviewed. Patients' subjective reports of abdominal pain were recorded as present or absent. Exam findings of the lower ribs, abdomen, and pelvis were each separately recorded as positive or negative, and were compared with findings on a subsequent objective evaluation of the abdomen (OEA). "Clinically significant" injuries were defined as those that would change patient management. Results: One thousand six hundred sixty-three patients were studied. Of patients with a negative abdominal exam, 10% had a positive OEA. When abdominal pain was absent, and exam of the lower ribs, abdomen, and pelvis was normal, OEA was positive in 7.6%, and 5.7% had a clinically significant injury. While a positive abdominal exam was predictive of a positive OEA (P < 0.01), a negative exam, even when broadened (pain, lower ribs, abdomen, pelvis) did not exclude significant injuries. Conclusion: Ten percent of trauma activation patients with a negative abdominal exam have occult abdominal/pelvic injuries. Even when exam of the lower ribs, abdomen, and pelvis are all negative and abdominal pain is absent, 5.7% have occult injuries that would change management. OEA should be used liberally for adult blunt trauma activation patients regardless of physical exam findings, to avoid missing clinically significant injuries.
AB - Background: To determine if physical examination can reliably detect or exclude abdominal or pelvic injury in adult trauma activation patients. Methods: Trauma registry and medical record data were retrospectively reviewed for all adult blunt trauma patients with Glasgow coma scale score > 8, from 6/30/05 to 12/31/06. Attending surgeons' dictated admission history and physical examination reports were individually reviewed. Patients' subjective reports of abdominal pain were recorded as present or absent. Exam findings of the lower ribs, abdomen, and pelvis were each separately recorded as positive or negative, and were compared with findings on a subsequent objective evaluation of the abdomen (OEA). "Clinically significant" injuries were defined as those that would change patient management. Results: One thousand six hundred sixty-three patients were studied. Of patients with a negative abdominal exam, 10% had a positive OEA. When abdominal pain was absent, and exam of the lower ribs, abdomen, and pelvis was normal, OEA was positive in 7.6%, and 5.7% had a clinically significant injury. While a positive abdominal exam was predictive of a positive OEA (P < 0.01), a negative exam, even when broadened (pain, lower ribs, abdomen, pelvis) did not exclude significant injuries. Conclusion: Ten percent of trauma activation patients with a negative abdominal exam have occult abdominal/pelvic injuries. Even when exam of the lower ribs, abdomen, and pelvis are all negative and abdominal pain is absent, 5.7% have occult injuries that would change management. OEA should be used liberally for adult blunt trauma activation patients regardless of physical exam findings, to avoid missing clinically significant injuries.
KW - abdominal examination
KW - abdominal trauma
KW - blunt trauma
KW - injury
KW - objective evaluation of the abdomen
KW - screening
KW - trauma
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U2 - 10.1016/j.jss.2009.04.046
DO - 10.1016/j.jss.2009.04.046
M3 - Article
C2 - 19786282
AN - SCOPUS:76749149455
SN - 0022-4804
VL - 159
SP - 456
EP - 461
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -