Clinical Review

Investigation of blunt abdominal trauma

BMJ 2008; 336 doi: 10.1136/bmj.39534.686192.80 (Published 24 April 2008)
Cite this as: BMJ 2008;336:938

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  1. Jan O Jansen, specialist registrar in general surgery1,
  2. Steven R Yule, consultant radiologist2,
  3. Malcolm A Loudon, consultant general surgeon1
  1. 1Department of Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
  2. 2Department of Radiology, Aberdeen Royal Infirmary
  1. Correspondence to: J Jansen jan.jansen{at}nhs.net
  • Accepted 21 March 2008

Summary points

  • The diagnosis of abdominal injury by clinical examination is unreliable

  • Blunt abdominal trauma requires decisive investigation and management

  • Ultrasound is the investigation of choice in haemodynamically unstable patients

  • Computed tomography is the investigation of choice in haemodynamically stable patients

  • Solid organ injury in haemodynamically stable patients can often be managed without surgery

Concealed haemorrhage is the second most common cause of death after trauma,1 and missed abdominal injuries are a frequent cause of morbidity and late mortality in patients who survive the early period after injury. Appropriate and expeditious investigation facilitates definitive management and minimises the risk of complications, so it is crucially important.

Sources and selection criteria

We searched the Medline database for reviews and clinical trials using the terms “blunt abdominal trauma”, “blunt abdominal injury”, “investigation”, “computed tomography”, “ultrasound”, “FAST”, and “diagnostic peritoneal lavage”. Search results were individually reviewed and manually cross referenced. We also searched the Cochrane Library and Clinical Evidence databases, reviewed guidelines from the American College of Radiology and the Royal College of Radiologists, and used references from our personal collections. The literature is dominated by non-randomised studies, and few systematic reviews and meta-analyses are available. Most of the evidence is level II-IV.

Several high quality prospective and retrospective studies have shown non-operative management of solid organ injury to be safe and effective, and this strategy is now accepted into mainstream practice.2 3 4 In parallel, a paradigm shift has occurred in imaging algorithms, with greater emphasis being put on the detection of specific findings, rather than the mere detection of intraperitoneal fluid, which does not predict the need for intervention.5 The greater availability of computed tomography and ultrasound in emergency departments has contributed to changes in practice, but it has also created new controversies—diagnostic peritoneal lavage is now rarely performed, but the diagnosis of hollow …

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