Suspicion of abdominal injuries in high-energy trauma patients: which clinical factors influence decision making for diagnostic imaging?

Abstract

Background: The choice of diagnostic imaging for high-energy trauma (HET) patients is highly debated. Currently, different diagnostic imaging is used in trauma centres to identify abdominal injuries. However, it remains unclear when physicians have a suspicion for abdominal injuries, and when diagnostic imaging is performed. Over-triage may lead to unnecessary diagnostics in relatively minor injured HET-patients.

Purpose: We investigated which clinical factors influence the decision to perform a focused assessment with sonography in trauma (FAST) or abdominal computed tomography (CT) in HET-patients. Additionally, we investigated which clinical factors determined whether HET-patients were admitted to the hospital or discharged from the emergency department.

Methods: We performed a retrospective data analysis of all HET-patients in a single level II trauma centre in the Netherlands, between June 2015 and January 2017.

Results: 316 HET-patients were included in this study. We found two clinical factors that proved to significantly predict whether a FAST or abdominal CT was performed: abdominal pain and the degree of concomitant injury. Furthermore, we found that the degree of concomitant injury as well as low haemoglobin levels proved to significantly predict whether a patient was admitted to the hospital for observation.

Conclusion: This study clarifies on which clinical factors the decision is taken to perform diagnostic imaging to identify abdominal injuries. Future prospective multicentre studies should clarify whether these clinical factors are trustworthy predictors of abdominal injuries, and whether patients can safely be discharged after trauma work-up.

Keywords:

• FAST
• high-energy trauma
• abdominal injuries
• decision-making

Acknowledgments

We thank Dr. J. Dieleman, epidemiologist, Máxima Medical Centre, Veldhoven, and M. van den Brink, epidemiologist, Elisabeth-Tweesteden Hospital, for reviewing the statistical analysis; L.A.A. Mignot, MD, emergency physician KNMG, Máxima Medical Centre, Veldhoven; J.J.L. Candel, MS, assistant professor for the University of Wageningen; J.H.J. Candel, MS, PhD, University of Wageningen; R. Verdonschot, MD, resident emergency medicine, Erasmus Medical Centre, Rotterdam, for reviewing the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).