Trauma Abdomen Davidnhfjhf
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Transcript of 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