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7/27/2019 Trauma Abdomen Davidnhfjhf

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THE INCIDENCE OF ABDOMINAL INJURY IN

PATIENTS WITH THORACIC AND/ PELVICTRAUMA

PEMBIMBING :

dr. Bambang Arianto, SpB

DIPRESENTASIKAN OLEH :

David Hermawan, S.Ked


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INTRODUCTION

An accurate history of the injury and astute

clinical examination are extremely valuable tools

Their effectiveness is often blunted in the trauma

situation particularly when the patient has

altered sensorium due to a concomitant head

injury

A more liberal use of diagnostic imaging for

trauma patients with suspected abdominal

injuries


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METHODS

SCOTTISH TRAUMA AUDIT GROUP (STAG) COLLECTS DATA ON

TRAUMA PATIENTS

HOSPITALISED FOR THREE DAYS OR WHO DIE AS AN RESULT OF THEIR

INJURIES

FOLLOWED UNTIL DISCHARGE, THREE MONTHS IN-PATIENT STAY OR

DEATH

AGE 13 - 65


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METHODS

THE AUDIT USES TRISS METHODOLOGY3 A COMBINATION OF THE

REVISED TRAUMA SCORE (RTS) THAT MEASURES PHYSIOLOGICAL

DERANGEMENT AND THE INJURY SEVERITY SCORE (ISS) WHICH

MEASURES ANATOMICAL DAMAGE

THE ABBREVIATED INJURY SCALE (AIS)16 IS A DETAILED TRAUMA

SCORING SYSTEM IN WHICH THE BODY IS SPLIT INTO SIX DIFFERENT

ANATOMICAL AREAS: HEAD AND NECK, ABDOMEN AND PELVIC

VISCERA, BONY PELVIS AND LIMBS, FACE, CHEST AND BODY SURFACE


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METHODS


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METHODS

USING THE STAG DATABASE FOR THE 5-YEAR PERIOD FROM 1997 TO

2001 INCLUSIVE, WE RETROSPECTIVELY EXAMINED THE FREQUENCY

OF SIGNIFICANT ABDOMINAL INJURY (AIS > 2, SEE TABLE 1 ) IN

RELATION TO VARYING SEVERITY OF CHEST AND/OR PELVIC TRAUMA

WE ALSO EXAMINED WHETHER THE INCIDENCE OF ABDOMINAL

TRAUMA VARIED IN RELATION TO PATIENT AGE, TYPE OF INJURY

(BLUNT OR PENETRATING) OR MECHANISM OF INJURY


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RESULTS


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RESULTS


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DISCUSSION

THESE RESULTS DEMONSTRATE THAT THE INCIDENCE OF

ABDOMINAL INJURY IS GREATLY INCREASED IN PATIENTS WITH

SERIOUS INJURIES TO BOTH THE CHEST AND THE PELVIS

DIAGNOSTIC PERITONEAL LAVAGE (DPL), THOUGH SENSITIVE FOR

THE DETECTION OF INTRA PERITONEAL, IS NOT ORGAN SPECIFIC12

AND CAN CAUSE INJURY.5

COMPUTED TOMOGRAPHY (CT) SCANNING CAN ACCURATELY

DELINEATE SOLID ORGAN DAMAGE WITHIN THE ABDOMEN AND CANRELIABLY DETECT INTRA PERITONEAL BLOOD.6,8,10


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DISCUSSION

ULTRASOUND (US) IS INCREASINGLY BECOMING AN INTEGRAL PART

OF ABDOMINAL ASSESSMENT IN THE TRAUMA SITUATION

IT IS BOTH SENSITIVE AND SPECIFIC1,2,7,14,9 AND CAN GREATLY

REDUCE THE NUMBER OF PATIENTS PROCEEDING TO DPL4 AND CT

SCANNING.4,13

THE FOCUSED ABDOMINAL SONOGRAM FOR TRAUMA OR FAST

SCAN IS A USEFUL METHOD OF SCREENING FOR

HAEMOPERITONEUM, HAEMOPERICARDIUM AND HAEMOTHORAXAFTER BLUNT TRAUMA


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DISCUSSION

IN THIS STUDY, PATIENTS WITH PENETRATING TRAUMA TO THE

CHEST HAD A GREATER INCIDENCE OF SIGNIFICANT ABDOMINAL

INJURY THAN THOSE WITH BLUNT TRAUMA

FINALLY, IMAGING IS AN IMPORTANT ADJUNCT TO, BUT IN NO WAY

REPLACES, SERIAL ASSESSMENTS BY A CLINICIAN WITH EXPERIENCE

IN THE MANAGEMENT OF TRAUMA


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CONCLUSION

WE CONCLUDE THAT PATIENTS WITH SERIOUS CHEST AND PELVIC

TRAUMA HAVE A MUCH HIGHER CHANCE OF SERIOUS INTRA-

ABDOMINAL INJURY THAN PATIENTS WITH EITHER CHEST OR PELVIC

TRAUMA IN ISOLATION

WE RECOMMEND A LOW THRESHOLD FOR THE USE OF DIAGNOSTIC

IMAGING OF THE ABDOMEN IN ALL PATIENTS WITH SIGNIFICANT

CHEST AND PELVIC TRAUMA


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SUMMARY

AMONGST PATIENTS WITH COMBINED CHEST AND PELVIC TRAUMA,

THE INCIDENCE OF ABDOMINAL INJURY INCREASED WITH SEVERITY

OF PELVIC AND CHEST INJURY

FOR PATIENTS WITH CHEST BUT NO PELVIC TRAUMA, INTRA

ABDOMINAL INJURY WAS SIGNIFICANTLY MORE COMMON

AMONGST PENETRATING THAN BLUNT TRAUMA

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