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Diagnostic options for blunt abdominal trauma

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A Correction to this article was published on 14 August 2020

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Abstract

Purpose

Physical examination, laboratory tests, ultrasound, conventional radiography, multislice computed tomography (MSCT), and diagnostic laparoscopy are used for diagnosing blunt abdominal trauma. In this article, we investigate and evaluate the usefulness and limitations of various diagnostic modalities on the basis of a comprehensive review of the literature.

Methods

We searched commonly used databases in order to obtain information about the aforementioned diagnostic modalities. Relevant articles were included in the literature review. On the basis of the results of our comprehensive analysis of the literature and a current case, we offer a diagnostic algorithm.

Results

A total of 86 studies were included in the review. Ecchymosis of the abdominal wall (seat belt sign) is a clinical sign that has a high predictive value. Laboratory values such as those for haematocrit, haemoglobin, base excess or deficit, and international normalised ratio (INR) are prognostic parameters that are useful in guiding therapy. Extended focused assessment with sonography for trauma (eFAST) has become a well established component of the trauma room algorithm but is of limited usefulness in the diagnosis of blunt abdominal trauma. Compared with all other diagnostic modalities, MSCT has the highest sensitivity and specificity. Diagnostic laparoscopy is an invasive technique that may also serve as a therapeutic tool and is particularly suited for haemodynamically stable patients with suspected hollow viscus injuries.

Conclusions

MSCT is the gold standard diagnostic modality for blunt abdominal trauma because of its high sensitivity and specificity in detecting relevant intra-abdominal injuries. In many cases, however, clinical, laboratory and imaging findings must be interpreted jointly for an adequate evaluation of a patient’s injuries and for treatment planning since these data supplement and complement one another. Patients with blunt abdominal trauma should be admitted for clinical observation over a minimum period of 24 h since there is no investigation that can reliably rule out intra-abdominal injuries.

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Authors and Affiliations

  1. Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Gerhard Achatz & Benedikt Friemert

  2. Department for General-, Visceral- and Thoracic-Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Kerstin Schwabe, Sebastian Brill, Roland Schmidt & Christian Beltzer

  3. Department for Vascular- and Endovascular-Surgery, German Armed Forces Hospital Ulm, Ulm, Germany

    Christoph Zischek

Authors
  1. Gerhard Achatz
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  2. Kerstin Schwabe
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  3. Sebastian Brill
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  4. Christoph Zischek
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  5. Roland Schmidt
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  6. Benedikt Friemert
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  7. Christian Beltzer
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Correspondence to Gerhard Achatz.

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Conflict of interest

Achatz Gerhard, Schwabe Kerstin, Brill Sebastian, Zischek Christoph, Schmidt Roland, Friemert Benedikt and Beltzer Christian declare that there is no conflict of interest regarding this paper and topic.

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For this study there were no test or experiments to humans or animals.

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The original version of this article was revised: In the author list, the first and last names were tagged incorrectly. The corrected author list is given above.

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Achatz, G., Schwabe, K., Brill, S. et al. Diagnostic options for blunt abdominal trauma. Eur J Trauma Emerg Surg 48, 3575–3589 (2022). https://doi.org/10.1007/s00068-020-01405-1

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