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Original article
Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma
  1. Michael M Neeki1,2,
  2. Dylan Hendy1,
  3. Fanglong Dong3,
  4. Jake Toy3,
  5. Kevin Jones1,
  6. Keasha Kuhnen1,
  7. Ho Wang Yuen1,2,
  8. Pamela Lux1,2,
  9. Arnold Sin1,2,
  10. Eugene Kwong1,
  11. David Wong4,5
  1. 1Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
  2. 2Department of Emergency Medicine, California University of Science and Medicine, Colton, California, USA
  3. 3College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
  4. 4Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA
  5. 5Department of Surgery, California University of Science and Medicine, Colton, California, USA
  1. Correspondence to Dr Michael M Neeki, Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA; michaelneeki{at}gmail.com

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.

  • blunt abdominal trauma
  • abdominal pain
  • abdominal tenderness
  • intra-abdominal injury

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000109

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    Footnotes

    • Contributors MMN and DW conceived the study. MMN, DW, KJ and KK contributed to the design of the study and development of study protocols. DW and AS were involved in the data collection and database compilation. FD performed statistical analyses. MMN, DH, JT, KK and KJ drafted the initial manuscript. MMN managed all aspects of the study. All authors contributed significantly during the revision process.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Institutional Review Board at Arrowhead Regional Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.