Predictors of "occult" intra-abdominal injuries in blunt trauma patients.

OBJECTIVE: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. METHODS: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. RESULTS: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05) lower mean AIS score for the head segment (1.0 ± 1.4 vs. 1.8 ± 1.9), as well as higher mean AIS thorax score (1.6 ± 1.7 vs. 0.9 ± 1.5) and ISS (25.7 ± 14.5 vs. 17,1 ± 13,1). The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3%) and in motorcyclists (36.0%) (p<0.001). The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64), presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14), run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85). CONCLUSION: Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

Predictors of "occult" intra-abdominal injuries in blunt trauma patients / Indicadores de lesões intra-abdominais "ocultas" em pacientes vítimas de trauma fechado admitidas sem dor abdominal ou alterações no exame físico do abdome

Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries) or Group 2 (without intra-abdominal injuries). Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05) lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9), as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5) and ISS (25.7±14.5 vs. 17,1±13,1). The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3%) and in motorcyclists (36.0%) (p<0.001). The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64), presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14), run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22) and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85). Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

Objetivo: avaliar os indicadores de lesões intra-abdominais em vítimas de trauma fechado admitidas sem dor abdominal ou alterações no exame físico do abdome. Método: estudo retrospectivo das vítimas de trauma fechado com idade superior a 13 anos, admitidas no período de 2008-2010. Selecionamos para estudo todos que foram submetidos à tomografia computadorizada de abdome e/ou laparotomia exploradora e que, à admissão, não apresentavam dor abdominal ou alterações ao exame físico do abdome. Os doentes foram separados em: Grupo 1 (com lesões intra-abdominais) e Grupo 2 (sem lesões intra-abdominais). As variáveis foram comparadas entre os grupos, considerando p<0,05 como significativo. Em um segundo passo, selecionamos as variáveis com p<0,20 na análise bivariada para criar modelo de regressão logística pelo método forward stepwise. Resultados: foram incluídos 268 casos. Os doentes com lesão abdominal caracterizaram-se por apresentar, significativamente (p<0,05), menor média de AIS em segmento cefálico (1,0 ± 1,4 vs. 1,8 ± 1,9), bem como, maior média de AIS em tórax (1,6 ± 1,7 vs. 0,9 ± 1,5) e de ISS (25,7 ± 14,5 vs. 17,1 ± 13,1). A frequência de lesões abdominais foi significativamente maior nas vítimas de atropelamentos (37,3%) e motociclistas (36%) (p<0,001). A regressão logística construiu um modelo utilizando as seguintes variáveis: motociclista como mecanismo de trauma (p<0,001- OR=5,51; IC95% 2,40-12,64), presença de fraturas de costelas (p<0,003 - OR=3,00; IC95% 1,47-6,14), atropelamento como mecanismo de trauma (p=0,008 - OR=2,85; IC95% 1,13-6,22) e exame físico neurológico anormal a admissão (p=0,015 - OR=0,44; IC95% 0,22-0,85). Conclusão: as lesões intra-abdominais foram relacionadas principalmente com o mecanismo de trauma e a presença de lesões torácicas.

Identifying severe abdominal injuries during the initial assessment in blunt trauma patients.

OBJECTIVE: To evaluate the predictive factors of severe abdominal injuries (SAI) identified in the initial assessment of blunt trauma victims. METHODS: A retrospective analysis of data from blunt trauma victims older than 13 years undergoing abdominal computed tomography and/or laparotomy was carried out. Serious injuries were considered with an Abbreviated Injury Scale (AIS) greater than or equal to three. Variables were compared between both A (SAI) and B (no SAI). We conducted an initial univariate statistical analysis to identify the variables associated with the presence of SAI. From these we selected those that had p<0.20 and could be evaluated on admission of the patient for multivariate analysis (logistic regression). RESULTS: The sample consisted of 331 cases and 140 (42.3%) patients had abdominal injuries. Of these, 101 (30.5%) had abdominal injury with AIS e" 3 (Group A). In univariate analysis, conditions significantly associated with the SAI (p<0.05): systolic blood pressure (SBP) in the pre-hospital setting (p = 0.019), SBP at admission (p<0.001), heart rate at admission (p = 0.047), altered physical examination of the abdomen (p <0.001) and the presence of pelvic fractures (p = 0.006). The following variables were significantly and independently correlated with the presence of severe abdominal injuries: SBP at admission (p = 0.034), altered abdominal physical examination (p<0.001), lower limb fracture (p<0.044), motorcycle accident as mechanism of injury (p = 0.017) and positive FAST (p <0.001). CONCLUSION: the variables present at baseline were significantly associated with the presence of SAI: SBP, physical examination, altered abdominal examination, presence of open fractures of the lower limb, motorcycle accident and positive FAST.

Identificação de lesões abdominais graves na avaliação inicial das vítimas de trauma fechado / Identifying severe abdominal injuries during the initial assessment in blunt trauma patients

OBJETIVO: avaliar os fatores preditivos de lesões abdominais graves (LAG) identificáveis na avaliação inicial das vítimas de trauma fechado. MÉTODOS: análise retrospectiva dos dados das vítimas de trauma fechado com idade superior a 13 anos submetidas à tomografia computadorizada do abdome e/ou laparotomia exploradora. Consideramos como graves as lesões com Abbreviated Injury Scale (AIS) maior ou igual a três. As variáveis foram comparadas entre os grupos A (LAG) e B (Sem LAG). Realizou-se inicialmente uma análise estatística univariada para identificar as variáveis associadas à presença de LAG. Destas, foram selecionadas para a análise multivariada (regressão logística) as que tivessem p<0,20 e pudessem ser avaliadas na admissão do doente. RESULTADOS: a amostra foi composta por 331 casos, sendo que 140 (42,3%) pacientes apresentaram lesões abdominais. Destes, 101 (30,5%) tinham lesão abdominais com AIS > 3 (Grupo A). Na análise univariada, associaram-se significativamente às LAG (p<0,05): pressão arterial sistólica (PAS) no pré-hospitalar (p=0,019), PAS à admissão (p<0,001), frequência cardíaca à admissão (p=0,047), exame físico do abdome alterado (p<0,001) e presença de fraturas de pelve (p=0,006). As seguintes variáveis se relacionaram significativamente e independentemente com a presença de lesões abdominais graves: PAS à admissão (p=0,034), exame físico abdominal alterado (p<0,001), fratura exposta de membro inferior (p<0,044), "motociclista" como mecanismo de trauma (p=0,017) e FAST positivo (p<0,001). CONCLUSÃO: das variáveis presentes na avaliação inicial, se associaram significativamente com a presença de LAG: PAS, exame físico abdominal alterado, presença de fratura exposta de membro inferior, "motociclista" como mecanismo de trauma e FAST positivo.

OBJECTIVE: To identify predictors of severe abdominal injuries using variables present in the initial assessment of blunt trauma patients. METHOD: retrospective analysis of charts and trauma data bank information including blunt trauma patients older than 13 y.o. who underwent abdominal assessment by computed tomography and/or laparotomy in a period of 18 months, starting in June 2008. Severity stratification was carried out with trauma indices (RTS, AIS, ISS and TRISS). Abdominal injuries were considered "severe" ifAIS > 3. Variables were compared between patients with SAI (group A) and without SAI (group B). Statistical analysis was carried out usingunivariate analysisinitially. We selected for logistic regression variables that would be present in the initial assessment (IA variables) and, additionally, had p<0.20 in the initial statistical analysis. RESULTS: Three hundred thirty one patients were included. Abdominal injuries were present in 140 (42.3%), being considered severe in 101 (30,5%) (Group A).Univariate analysis showed that variables significantly associated with SAI (p<0.05) in the initial analysis were: pre hospital Systolic Arterial Blood Pressure (SAP) (p=0.019), admission SAP (p<0.001), admission heart rate (p=0.047), positive abdominal physical exam on admission(p<0.001) and pelvic fractures (p=0.006). Logistic regression identified five independent factors related to SAI (IA variables): SAP (p=0.034), positive abdominal physical exam (p<0.001), open lower limbs fractures (p<0.044), motorcyclist as trauma mechanism (p=0.017) and positive FAST (p<0.001). CONCLUSION: IA variables significantly associated with SAI were SAP, positive abdominal physical examination, open lower limbs fractures, motorcyclist as mechanism of trauma and positive FAST.