The ACEP offices will be closed for several upcoming holidays
We apologize for any inconvenience:
Thursday, November 28, 2024 and Friday, November 29, 2024.
Monday, December 23, 2024 thru Wednesday, January 1, 2025.
ACEP ID:
Scope of Application
This guideline is intended for physicians working in hospital-based emergency departments.
Inclusion Criteria
This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma.
Exclusion Criteria
This guideline is not intended to address the care of pediatric patients or pregnant women.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
In a hemodynamically unstable patient with blunt trauma is bedside ultrasound the diagnostic modality of choice?
In hemodynamically unstable patients (systolic blood pressure ≤90 mm Hg) with blunt trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy.
In hemodynamically unstable patients (systolic blood pressure ≤90 mm Hg) with blunt trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy.
Does oral contrast improve the diagnostic performance of computed tomography (CT) in blunt trauma?
Oral contrast is not required in the diagnostic imaging for evaluation of blunt trauma.* *All of the studies reviewed included the use of intravenous (IV) contrast.
Oral contrast is not required in the diagnostic imaging for evaluation of blunt trauma.* *All of the studies reviewed included the use of intravenous (IV) contrast.
In a clinically stable patient with isolated blunt trauma, is it safe to discharge the patient after a negative abdominal computed tomography (CT) scan result?
None specified.
Clinically stable patients with isolated blunt trauma can be safely discharged after a negative result for abdominal CT with intravenous (IV) contrast (with or without oral contrast).
Further observation, close follow-up, and/or imaging may be warranted in select patients based on clinical judgment.
None specified.
Clinically stable patients with isolated blunt trauma can be safely discharged after a negative result for abdominal CT with intravenous (IV) contrast (with or without oral contrast).
Further observation, close follow-up, and/or imaging may be warranted in select patients based on clinical judgment.
In patients with isolated blunt trauma, are there clinical predictors that allow the clinician to identify patients at low risk for adverse outcome who do not need a computed tomography (CT)?
None specified.
None specified.
Patients with isolated trauma, for whom occult abdominal injury is being considered, are at low risk for adverse outcome and may not need CT scanning if the following are absent: tenderness, hypotension, altered mental status (Glasgow Coma Scale score <14), costal margin tenderness, abnormal chest radiograph, hematocrit<30% and hematuria.* *Hematuria is defined variably in different studies, with the lowest threshold being greater than or equal to 25 RBCs/high-power field (HPF).
None specified.
None specified.
Patients with isolated trauma, for whom occult abdominal injury is being considered, are at low risk for adverse outcome and may not need CT scanning if the following are absent: tenderness, hypotension, altered mental status (Glasgow Coma Scale score <14), costal margin tenderness, abnormal chest radiograph, hematocrit<30% and hematuria.* *Hematuria is defined variably in different studies, with the lowest threshold being greater than or equal to 25 RBCs/high-power field (HPF).
