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PubMed1969

The management of abdominal injuries in the presence of head injury.

When head and blunt abdominal injuries are combined, the head injury is often afforded too much attention and the abdominal injury too little, especially when the patient is unconscious. If mismanaged, the abdominal injury is often the more serious threat to life. Except for extradural hemorrhage, neurosurgical intervention, when indicated, can be delayed until the patient has been thoroughly evaluated for the presence of extra cranial injuries with higher therapeutic priority. Abdominal examination of the unconscious or uncooperative patient is difficult. Tenderness as a sign of abdominal injury cannot be elicited. Abdominal rigidity (in the absence of rigid extremities), a silent abdomen, shock, and extreme restlessness may indicate intra-abdominal changes. Abdominal paracentesis is a valuable diagnostic aid, and the finding of blood, bile-stained fluid, intestinal contents or air is an indication for immediate laparotomy. Once all injuries are known, priorities for treatment can be assigned. Often head and abdominal injuries can be treated concomitantly.

Abdominal Injuries↗
PubMed2004

Optimal restraint reduces the risk of abdominal injury in children involved in motor vehicle crashes.

BACKGROUND: The American Academy of Pediatrics has established guidelines for optimal, age-appropriate child occupant restraint. While optimal restraint has been shown to reduce the risk of injuries overall, its effect on specific types of injuries, in particular abdominal injuries, has not been demonstrated. METHODS: Cross-sectional study of children aged younger than 16 years in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 10927 crashes involving 17132 restrained children, representing 210926 children in 136734 crashes was collected between December 1, 1998 and May 31, 2002. Restraint use was categorized as optimal or suboptimal based on current American Academy of Pediatrics guidelines. The outcome of interest, abdominal injury, was defined as any reported injury to an intra-abdominal organ of Abbreviated Injury Scale >or=2 severity. RESULTS: Among all restrained children, optimal was noted in 59% (n = 120473) and suboptimal in 41% (n = 83555). An associated abdominal organ injury was noted in 0.05% (n = 62) of the optimal restrained group and 0.17% (n = 140) of the suboptimal group. After adjusting for age and seating position (front vs. rear), optimally restrained children were more than 3 times less likely [odds ratio 3.51 (95% confidence interval, 1.87-6.60, P < 0.001)] as suboptimally restrained children to suffer an abdominal injury. Of note, there were no abdominal injuries reported among optimally restrained 4- to 8-year-olds. CONCLUSIONS: Optimally restrained children are at a significantly lower risk of abdominal injury than children suboptimally restrained for age. This disparity emphasizes the need for aggressive education efforts aimed not only at getting children into restraint systems, but also the importance of optimal, age-appropriate restraint.

Abdominal Injuries↗
PubMed1997

[Peculiarities of clinical aspects of moderate abdominal injuries concurrent with cranio-cerebral injuries].

Analysis of 89 observations of nonsevere injuries of abdominal cavity and retroperitoneal space, concurrent with craniocerebral trauma is given. In 62.9% of observations, in such a leind of trauma, laparocentesis or the other microlaparotomic interventions had to be conducted. Without of such interventions conduction the abdominal trauma character succeeded to diagnose only in 24.7% of observations, in 12.4% patients the abdominal, injuries appeared as the autopsy finds.

Abdominal Injuries↗
PubMed2004

Large animal-related abdominal injuries.

BACKGROUND: This study investigated injuries to the abdominal area of the body caused by large animals, as well as the management of this problem. METHODS: All the patients with large animal-related abdominal injuries over a 10-year period were identified retrospectively through the general surgery registrations. RESULTS: Overall, 113 patients were hospitalized after large animal encounters during the 10-year study period, 33 (30%) of which had large animal-related abdominal injuries. These patients comprised 10 women (30%) and 23 men (70%) with a mean age of 56 +/- 14 years. Of the 33 patients, 31 (93.9%) sustained blunt injuries and 2 (6.1%) experienced penetrating abdominal trauma. The mean Injury Severity Score was 12.7 +/- 4.0, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 10.6 +/- 3.2. The mean intensive care unit stay was 0.8 +/- 2.2 days, and the total hospital length of stay was 7.3 +/- 5.6 days. Whereas 12 patients (36.4%) were managed nonoperatively, 21 patients (63.6%) required surgery. Laparotomy showed injuries to the jejunum in three patients (9.1%), to the ileum in 13 patients (39.4%), to the ileal mesenterium in 1 patient (3%), to the liver in 4 patients (12.1%), and to the spleen in 2 patients (6.1%). One patient died of myocardial infarction on the second day after admission. CONCLUSIONS: Large animal-related injuries to the abdominal area can be serious. Immediate transportation and early diagnosis of abdominal insults are important because of the frequencies of small bowel and mesenteric injuries, which are difficult to diagnose using currently available diagnostic tools.

APACHE↗
PubMed2004

Analysis of injury criteria to assess chest and abdominal injury risks in blunt and ballistic impacts.

BACKGROUND: The Viscous Criterion (VC) is an experimental measure developed by the automotive industry to assess injury risks for high-speed impacts. The Blunt Criterion (BC) is a prospective measure developed by the Department of Defense to predict injury from blunt projectiles. METHODS: The range of applicability of BC was extended and compared with VC for its ability to assess injury risk using published cadaver and animal data. Department of Defense projectiles were 0.05 to 0.43 kg mass at velocities up to 86 m/s. VC data were generated from impacts with 1.75 to 23.4 kg at 3.6 to 10.2 m/s. Chest and abdominal injuries ranged from Abbreviated Injury Scale scores of 1 to 6. RESULTS: Both criteria correlated very well with the experimental data, demonstrating correlation coefficients of R = 0.84 to 0.96. The correlation between VC and BC was R = 0.99. Logistic probability curves were derived to predict blunt impact injuries of Abbreviated Injury Scale scores of 1 to 6 for the chest and abdomen. CONCLUSION: BC and VC are virtually identical in their ability to assess blunt and ballistic impact injury risks. They are different measures of impact energy absorbed by the body. One is predictive using input parameters, and the other measures the impact response of the body.

Abbreviated Injury Scale↗
PubMed1984

[Abdominal injuries. Value of emergency abdominal echotomography].

The purpose of this study was to evaluate the usefulness of abdominal ultrasonic tomography, among other methods, to detect visceral lesions in multiple traumas of the abdomen. Forty-seven case-records of abdominal traumas observed over an 8-month period were selected. We used a real-time sectorial ultrasound scanner with a 3.5 MHz probe. Positive results were obtained in 11 patients who were operated upon. None of the 33 patients with negative results and only one of the 3 patients with doubtful results underwent surgery. We found that suggestive symptoms were compatible with the absence of any severe visceral lesion and, conversely, that patients with multiple traumas but little suggestive symptoms could present with one or several intra-abdominal lesions. Abdominal ultrasonic tomography can rapidly be performed and its indications are different from, but wider than, those of peritoneal lavage. It is a safe and reliable emergency examination which does not interfere with resuscitation procedures.

Abdominal Injuries↗
PubMed1985

Peritoneal lavage in closed abdominal injury.

Peritoneal lavage is a sensitive method of detecting intra-abdominal injuries following closed abdominal injury. Our indications for peritoneal lavage are: severe head injury, severe thoracic injury, unexplained hypotension in a patient with possible blunt abdominal injury and patients on artificial ventilation. We present 40 patients with multiple injuries who underwent peritoneal lavage for suspected closed abdominal injury. Twenty-two lavages were positive and 19 laparotomies were performed, of which 18 revealed intra-abdominal injuries. Eighteen lavages were negative; no laparotomy was performed in this group. There was one false positive, but no false negative lavage.

Abdominal Injuries↗
PubMed1990

[Poly-, multiple trauma and intra-abdominal injuries].

The present work deals with the problem of abdominal injuries in polytraumatized patients. The results were obtained from a retrospective study of the records of 530 polytraumatized patients treated at the Central Hospital of the German Federal Armed Forces (Bundeswehr). In all, 193 of these patients had abdominal injuries. The overall mortality was 23.8% (n = 126): mortality among the patients with abdominal injuries was 26% (n = 50). Abdominal injuries alone led to death in 9.1% (n = 1), but mortality increased to 18.4% when at least one extra-abdominal injuries was also present. A combination of abdominal injuries and two or more extra-abdominal lesion led to a mortality rate of 27%. Mortality was found to be age- and sex-related: in young children and patients over 55 years (especially those around 70) mortality was 33.3%-72%. Among the cases with fatal outcome there was a female-to-male ratio of 3:2. The most common causes of death were: hemorrhage shock (62.3%), head injuries (37.7%), septicemia (8.1%), pneumonia, and ARDS (5.4% each). Within the last eight years we have used the following supplementary examination methods: computed tomography, peritoneal lavage, and ultrasonography. The retrospective study has shown that CT is not the examination of choice. The reliability with lavage and ultrasonography was approximately the same, but lavage was found to be more dangerous. Therefore, we abandoned lavage and used sonography only. However, we are of the opinion that any surgeon should use the examination method that has yielded the best results for him or her, to ensure the best possible outcome for the patient.

Abdominal Injuries↗
PubMed2005

Hyperacute abdominal compartment syndrome: an unrecognized complication of massive intraoperative resuscitation for extra-abdominal injuries.

Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperatively while repair of extra-abdominal injuries is being carried out simultaneous with massive resuscitation for shock caused by those injuries. The charts of patients requiring abdominal decompression (AD) for HACS at time of extra-abdominal surgery at our level I trauma center were reviewed. The following data was gathered: age, Injury Severity Score (ISS), mechanism, resuscitation details, time to AD, time to abdominal closure, and outcome. All continuous data are presented as mean +/- standard error of mean. Hemodynamic and ventilatory data pre- and post-AD was compared using paired t test with significance set at P < 0.05. Five (0.13%) of 3,750 trauma admissions developed HACS during the 15-month study period ending February 2004. Mean age was 32 +/- 7 years, and mean ISS was 19 +/- 2. Four of five patients arrived in hemorrhagic shock (blunt subclavian artery injury, 1; chest gunshot, 1; gunshot to brachial artery, 1; stab transection of femoral vessels, 1) and were immediately operated upon. One of five patients (70% burn) developed HACS during burn wound excision on day 2. HACS developed after massive crystalloid (15 +/- 1.7 L) and blood (11 +/- 0.4 units) resuscitation during prolonged surgery (4.8 +/- 0.8 hours). Pre- versus post-AD comparisons revealed significant (P < 0.05) improvements in mean arterial pressure (55 +/- 6 vs 88 +/- 3 mm Hg), peak airway pressure (44 +/- 5 vs 31 +/- 2 mm Hg), tidal volume (432 +/- 96 vs 758 +/- 93 mL), arterial pH (7.16 +/- 0.0 vs 7.26 +/- 0.04), and PaCO2 (52 +/- 6 vs 45 +/- 6 mm Hg). There was no mortality among the group, and all patients underwent abdominal closure by fascial reapproximation in 2-5 days. Two (40%) of the five patients required extremity fasciotomy for compartment syndrome. HACS is a rare complication of massive resuscitation for extra-abdominal injuries. It should be considered in such patients in the face of unexplained hemodynamic and/or ventilatory decompensation. Prompt AD is life saving. Early abdominal closure is usually possible. Vigilance for compartment syndromes elsewhere in the body is warranted in any patient with HACS.)

Abdomen↗
PubMed1978

[Seat belt related abdominal injuries (author's transl)].

Seat belts reduce the severity of trauma in car accidents. There is a definite decrease in the percentage of head injuries, while abdominal lesions seem to increase. Experimental and clinical investigations show a predominance of abdominal wall injuries and liver ruptures. The seat belt syndrome requires close observation of the patient in the intensive care unit. An increasing number of late intestinal obstructions after a seat belt injury due to lesions of the intestinal wall are reported.

Abdominal Injuries↗
PubMed1999

Blunt abdominal injuries.

The management of blunt abdominal injury (BAI) has undergone quite significant changes over recent years. The emphasis is now on the recognition and limitation of the underlying metabolic insult associated with severe abdominal injury. The concepts of damage control and non-operative management while seeming diametrically opposed have both found favour in selected patient groups. The interventional radiologist has opened a new dimension in the control of inaccessible bleeding and is able to contribute to non-operative approaches. The complimentary use of the methods of investigation available for BAI will also improve the accuracy and specificity of diagnosis allowing more appropriate management. Embracing these new concepts of management by all institutions dealing with trauma victims will hopefully reduce the morbidity and mortality of BAI.

Abdominal Injuries↗
PubMed1994

Abdominal injury score: a clinical score for the assignment of risk in children after blunt trauma.

PURPOSE: To develop a clinical scoring scheme that can be used to predict the risk of abdominal injury in children after blunt trauma. MATERIALS AND METHODS: Presenting clinical features and outcomes, including the need for surgery, were reviewed for 793 children who underwent computed tomography (CT) after blunt abdominal trauma. These data were submitted to a logistic regression model to identify predictors for major abdominal injury. An abdominal injury score was developed on the basis of results of these analyses; higher scores denoted a progressively higher risk. RESULTS: The proportion of children with abdominal injury increased significantly with progressively higher scores (P = .0001). There was no significant difference between the predicted and actual frequency distributions of abdominal injury (P = .782). Patients were assigned to low-, intermediate-, and high-risk groups according to abdominal injury score, with a predicted probability of abdominal injury for each group of < or = 5%, 6%-15%, and > or = 16%, respectively. Frequency of major abdominal injury increased with higher scores, as did the need for laparotomy. CONCLUSION: The abdominal injury score shows promise as a useful tool for triage of children considered for emergency CT after blunt abdominal trauma.

Abdominal Injuries↗
PubMed1997

Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST)

BACKGROUND: Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. METHODS: Clinical, radiologic, and FAST data were collected prospectively on BTVs over a 12-month period. All patients with FAST-negative for hemoperitoneum were further analyzed. Examination findings and associated injuries were evaluated for association with abdominal lesions. RESULTS: Of 772 BTVs undergoing FAST, 52 (7%) had abdominal injury. Fifteen of 52 (29%) had no hemoperitoneum by admission computed tomographic scan, and all had FAST interpreted as negative. Four patients with splenic injury underwent laparotomy. Six other patients with splenic injury and five patients with hepatic injury were managed nonoperatively. Clinical risk factors significantly associated with abdominal injury in BTVs without hemoperitoneum include: abrasion, contusion, pain, or tenderness in the lower chest or upper abdomen; pulmonary contusion; lower rib fractures; hemo- or pneumothorax; hematuria; pelvic fracture; and thoracolumbar spine fracture. CONCLUSIONS: Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.

Abdominal Injuries↗
PubMed2004

Critical concepts in abdominal injury.

Missed intra-abdominal injuries are among the most frequent causes of potentially preventable trauma deaths. The evaluation and management of abdominal trauma is dependant on multiple factors, including mechanism of injury, location of injury, hemodynamic status of the patient, neurologic status of the patient, associated injuries, and institutional resources.

Abdominal Injuries↗
PubMed1998

[Abdominal injuries in children. The value of emergency abdominal ultrasonography].

UNLABELLED: Abdominal injuries are frequent in children. Their early assessment is the best guarantee for an accurate management. PATIENTS AND METHODS: Seventy children with abdominal trauma were evaluated by early ultrasonography. RESULTS: This investigation found abnormalities in 52 patients, with hematic peritoneal effusion in 26 cases, renal lesion in 20 cases, hepatic lesion in ten cases, splenic lesion in seven cases and a lesion involving liver, spleen and pancreas in one case. Based on these results, surgery was performed in six cases. The remaining cases were simply supervised with a good prognosis. CONCLUSION: Ultrasonography represents the main investigation in children's abdominal trauma, allowing an early, efficient and non-costly morphological diagnosis. Computerized tomography (CT) scan has some particular indications.

Abdominal Injuries↗