Evaluation of blunt abdominal trauma with a protocol using both diagnostic peritoneal lavage and computed tomography

ABSTRACT

The purpose of this study is to try to evaluate blunt abdominal trauma patients for presence of intra-abdominal injury rapidly and effectively .A protocol is tested combining and selecting the use of physical examination, diagnostic peritoneal lavage [DPL] and abdominal computed tomography [C.T] with the aim to avoid missing injuries or to do non therapeutic laparotomies and also aiming to reduce health cost. Preprotocol period [20 months] include 651 cases that were triaged according to haemodynamic stability and result of abdominal examination, into 3 groups. Group I [stable patients with suspicious or unreliable abdominal examination] include 150 patients that were evaluated by abdominal CT. Group II [unstable patients] include 52 patients that were evaluated by DPL alone. Group III [stable patients with reliable and normal or mildly symptomatic abdomen] include 449 patients that were evaluated by physical examination alone. The protocol period [16 months] include 512 patients that were triaged, as in the pre-protocol period, into group l[153 patients], group ll[26 patients] and group III [333 patients]. Evaluation in groups II and III were the same as in the pre protocol period while in group I cases were evaluated by DPL followed in positive cases by abdominal C.T to decide upon conservative treatment. The results in groups II and III were comparable in both pre-protocol and protocol groups. However in group I in the protocol period there is drop in the use of emergency C.T from 23% to 8%, drop in missed injuries from 6% to zero% and no non therapeutic laparotomies were done in either the protocol or pre-protocol period. This protocol is recommended to be used in the evaluation of blunt abdominal trauma patients