Identifying severe abdominal injuries during the initial assessment in blunt trauma patients.

OBJECTIVE To evaluate the predictive factors of severe abdominal injuries (SAI) identified in the initial assessment of blunt trauma victims. METHODS A retrospective analysis of data from blunt trauma victims older than 13 years undergoing abdominal computed tomography and/or laparotomy was carried out. Serious injuries were considered with an Abbreviated Injury Scale (AIS) greater than or equal to three. Variables were compared between both A (SAI) and B (no SAI). We conducted an initial univariate statistical analysis to identify the variables associated with the presence of SAI. From these we selected those that had p<0.20 and could be evaluated on admission of the patient for multivariate analysis (logistic regression). RESULTS The sample consisted of 331 cases and 140 (42.3%) patients had abdominal injuries. Of these, 101 (30.5%) had abdominal injury with AIS e" 3 (Group A). In univariate analysis, conditions significantly associated with the SAI (p<0.05): systolic blood pressure (SBP) in the pre-hospital setting (p = 0.019), SBP at admission (p<0.001), heart rate at admission (p = 0.047), altered physical examination of the abdomen (p <0.001) and the presence of pelvic fractures (p = 0.006). The following variables were significantly and independently correlated with the presence of severe abdominal injuries: SBP at admission (p = 0.034), altered abdominal physical examination (p<0.001), lower limb fracture (p<0.044), motorcycle accident as mechanism of injury (p = 0.017) and positive FAST (p <0.001). CONCLUSION the variables present at baseline were significantly associated with the presence of SAI: SBP, physical examination, altered abdominal examination, presence of open fractures of the lower limb, motorcycle accident and positive FAST.