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Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours

Jones, Edward L. MD, MS; Stovall, Robert T. MD; Jones, Teresa S. MD, MS; Bensard, Denis D. MD; Burlew, Clay Cothren MD; Johnson, Jeffrey L. MD; Jurkovich, Gregory Jerry MD; Barnett, Carlton C. MD; Pieracci, Frederic M. MD; Biffl, Walter L. MD; Moore, Ernest E. MD

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 1020–1023
doi: 10.1097/TA.0000000000000131
Original Articles

BACKGROUND The diagnosis of blunt abdominal trauma can be challenging and resource intensive. Observation with serial clinical assessments plays a major role in the evaluation of these patients, but the time required for intra-abdominal injury to become clinically apparent is unknown. The purpose of this study was to determine the amount of time required for an intra-abdominal injury to become clinically apparent after blunt abdominal trauma via physical examination or commonly followed clinical values.

METHODS A retrospective review of patients who sustained blunt trauma resulting in intra-abdominal injury between June 2010 and June 2012 at a Level 1 academic trauma center was performed. Patient demographics, injuries, and the amount of time from emergency department admission to sign or symptom development and subsequent diagnosis were recorded. All diagnoses were made by computed tomography or at the time of surgery. Patient transfers from other hospitals were excluded.

RESULTS Of 3,574 blunt trauma patients admitted to the hospital, 285 (8%) experienced intra-abdominal injuries. The mean (SD) age was 36 (17) years, the majority were male (194 patients, 68%) and the mean (SD) Injury Severity Score (ISS) was 21 (14). The mean (SD) time from admission to diagnosis via computed tomography or surgery was 74 (55) minutes. Eighty patients (28%) required either surgery (78 patients, 17%) or radiographic embolization (2 patients, 0.7%) for their injury. All patients who required intervention demonstrated a sign or symptom of their intra-abdominal injury within 60 minutes of arrival, although two patients were intervened upon in a delayed fashion. All patients with a blunt intra-abdominal injury manifested a clinical sign or symptom of their intra-abdominal injury, resulting in their diagnosis within 8 hours 25 minutes of arrival to the hospital.

CONCLUSION All diagnosed intra-abdominal injuries from blunt trauma manifested clinical signs or symptoms that could prompt imaging or intervention, leading to their diagnosis within 8 hours 25 minutes of arrival to the hospital. All patients who required an intervention for their injury manifested a sign or symptom of their injury within 60 minutes of arrival.

LEVEL OF EVIDENCE Therapeutic study, level IV. Epidemiologic study, level III.

From the Denver Health Medical Center, Denver, Colorado.

Submitted: July 28, 2013, Revised: November 12, 2013, Accepted: November 13, 2013.

Address for reprints: Robert T. Stovall, MD, University of Colorado School of Medicine, Denver, Denver Health Medical Center, 777 Bannock Street, MC 0206, Denver, CO 80204 email:

© 2014 Lippincott Williams & Wilkins, Inc.