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Trauma (Acute Blunt Abdominal - Adult)

Evaluation of Adult Emergency Department Patients with Acute Blunt Abdominal Trauma (January 2011) 

Complete Clinical Policy on Blunt Abdominal Trauma  (PDF)

Scope of Application. This guideline is intended for physicians working in hospital-based emergency departments.

Inclusion Criteria. This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma.

Exclusion Criteria. This guideline is not intended to address the care of pediatric patients or pregnant women.

Critical Questions  

1. In a hemodynamically unstable patient with blunt abdominal trauma is bedside ultrasound the diagnostic modality of choice?  

  • Level A recommendations. None specified. 

     
  • Level B recommendations. In hemodynamically unstable patients (systolic blood pressure ≤90 mm Hg) with blunt abdominal trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy. 

     
  • Level C recommendations. None specified. 
     

2. Does oral contrast improve the diagnostic performance of computed tomography (CT) in blunt abdominal trauma?  

  • Level A recommendations. None specified. 

     
  • Level B recommendations. Oral contrast is not required in the diagnostic imaging for evaluation of blunt abdominal trauma.*
        *All of the studies reviewed included the use of intravenous (IV) contrast. 

     
  • Level C recommendations. For patients with a negative CT scan result with IV contrast only, in whom there is high suspicion of bowel injury, further evaluation or close follow-up is indicated. 
     

3. In a clinically stable patient with isolated blunt abdominal trauma, is it safe to discharge the patient after a negative abdominal computed tomography (CT) scan result?  

  • Level A recommendations. None specified. 

     
  • Level B recommendations. Clinically stable patients with isolated blunt abdominal trauma can be safely discharged after a negative result for abdominal CT with intravenous (IV) contrast (with or without oral contrast). 

     
  • Level C recommendations. Further observation, close follow-up, and/or imaging may be warranted in select patients based on clinical judgment.

     

4. In patients with isolated blunt abdominal trauma, are there clinical predictors that allow the clinician to identify patients at low risk for adverse outcome who do not need an abdominal computed tomography (CT)?  

  • Level A recommendations. None specified. 

     
  • Level B recommendations. None specified. 

     
  • Level C recommendations. Patients with isolated abdominal trauma, for whom occult abdominal injury is being considered, are at low risk for adverse outcome and may not need abdominal CT scanning if the following are absent: abdominal tenderness, hypotension, altered mental status (Glasgow Coma Scale score <14), costal margin tenderness, abnormal chest radiograph, hematocrit <30% and hematuria.*
        *Hematuria is defined variably in different studies, with the lowest threshold being greater than or equal to 25 RBCs/high-power field (HPF). 
     

Purpose of ACEP's Clinical Policies 

Clinical Findings and Strength of Recommendations