DOI: http://dx.doi.org/10.18203/2349-2902.isj20215152

Blunt abdominal trauma: initial resuscitation followed by clinical and focused abdominal sonography assessment important diagnostic tools of organ injury due to restricted use of CT-scan in a tertiary care in India

S. K. Sekendar Ali, Narendra Nath Mukhopadhyay, Jyotirmoy Bhattacharya, Madhusudan Chattopadhyay

Abstract


Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Objective was to evaluate the role of clinical and ultrasound assessment in early diagnosis of intra-abdominal injury following blunt abdominal trauma and follow up in patients with intraabdominal injury for detecting complications.

Methods: 130 patients who presented to the emergency room were evaluated by clinical and focused abdominal sonography for trauma (FAST) and follow-up sonography was done after 6-12 hours upto 72 hours.

Results: In our study, road traffic accidents (RTA) were the most common cause of blunt abdominal trauma (70.76%) with 75% patients being were males. X-ray erect abdomen and ultrasound of the abdomen were the most sensitive investigation for hollow viscous injury and solid organ injuries, respectively, with bowel (38.33%) and liver injury (26.67%) being the most common organ involved in this study. This study found sensitivity (93.7%) and specificity (98.5%) of focused abdominal ultrasonography (FAST).

Conclusions: Initial resuscitation followed by clinical and ultrasonography assessment is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time and also due to restricted use of modern amenities such as CT-scan in tertiary care in India.


Keywords


Blunt abdominal trauma, FAST assessment, Road traffic accident, Ultrasound by general surgeon

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References


World Health Organization (WHO). Injuries and Violence: The Facts 2014. Geneva, Switzerland: WHO Press; 2014.

Roy N, Veetil KD, Khajanchi MU, Kumar V, Solomon H, Kamble J, et al. Learning from 2523 trauma deaths in India opportunities to prevent in-hospital deaths. BMC Health Serv Res. 2017;17(1):142.

Karamercan A, Yilmaz TU, Karamercan MA. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Travma Acil Cerrahi Derg. 2008;14(3):205-10.

Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg. 1976;183(6):672-8.

Kendall JL, Kestler AM, Whitaker KT, Adkisson MM, Haukoos JS. Blunt abdominal trauma patients are at very low risk for intraabdominal injury after emergency department observation. West J Emerg Med. 2010;12(4):496-504.

Mohammadi A, Ghasemi-Rad M. Evaluation of gastrointestinal injury in blunt abdominal trauma ‘‘FAST is not reliable’’: the role of repeated ultrasonography. World J Emerg Surg. 2012;7(1):2.

Tsui CL, Fung HT, Chung KL, Kam CW. Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma. Int J Emerg Med. 2008;1:183-7.

Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129-34.

Farrath S, Parreira JG, Perlingeiro JA, Solda SC, Assef JC. Predictors of abdominal injuries in blunt trauma. Rev Col Bras Cir. 2012;39(4):295-301.

Hedrick TL, Sawyer RG, Young JS. MRI for the diagnosis of blunt abdominal trauma: a case report. Emerg Radiol. 2005;11(5):309-11.

Cokkino D, Antypa E, Stefanidis K, Tserotas P, Kostaras V, Parlamenti A, et al. Contrast-enhanced ultrasound for imaging blunt abdominal trauma- indications, description of the technique and imaging review. Ultraschall Med. 2012;33(1):60-7.

Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. BMJ. 2008;336(7650):938-42.

Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. AJR. 2007;188(2):415-21.

Jalli R, Kamalzadeh N, Lotfi M, Farahangiz S, Salehipour M. Accuracy of sonography in detection of renal injuries caused by blunt abdominal trauma: a prospective study. Ulus Travma Acil Cerrahi Derg. 2009;15(1):23-7.

Korner M, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. RadioGraphics. 2008;28:225-42.

Sato M, Yoshii H. Reevaluation of ultrasonography for solid-organ injury in blunt abdominal trauma. J Ultrasound Med. 2004;23(12):1583-96.