From the Guidelines
Serial abdominal examinations are crucial in the management of blunt abdominal trauma to detect delayed or evolving intra-abdominal injuries, and should be performed every 4-6 hours for at least 24 hours by the same examiner when possible. The purpose of these examinations is to identify deterioration that might indicate internal bleeding, hollow viscus injury, or solid organ damage requiring intervention. This approach is particularly valuable because some injuries, such as those to the bowel, pancreas, or retroperitoneal structures, may develop symptoms gradually over hours to days 1. Key aspects to focus on during these examinations include changes in vital signs, abdominal tenderness, distension, guarding, or rigidity. The serial examination approach reduces unnecessary imaging and invasive procedures while ensuring timely intervention when needed, thus balancing the risks of missed injuries against unnecessary interventions in trauma management 1. It is also important to note that the accuracy of clinical assessment increases with serial examinations as part of non-operative management, allowing for the identification of patients who may require further diagnostic studies or surgical intervention 1. Furthermore, a high index of suspicion and prompt decision-making are critical in the management of blunt abdominal trauma, as delays in diagnosis and treatment can lead to increased morbidity and mortality 1. In patients with high-risk mechanisms of injury or equivocal initial findings, serial abdominal examinations should be complemented with other diagnostic tools, such as CT scans and laboratory tests, to ensure timely detection of potential complications. Overall, serial abdominal examinations are a vital component of the management of blunt abdominal trauma, and should be performed in a systematic and thorough manner to ensure the best possible outcomes for patients.
From the Research
Purpose of Serial Abdominal Examinations
The purpose of serial abdominal examinations in the management of blunt abdominal trauma is to:
- Monitor patients for potential development of free intraperitoneal fluid, as initial screenings may be negative but become positive upon repeated examination 2
- Diagnose significant injuries as soon as possible and avoid delayed or missed diagnoses 3
- Guide nonoperative management of known intraperitoneal trauma, in conjunction with diagnostic tools such as computed tomography 4, 5
- Rapidly assess patients and assist in their management, particularly in cases where nurses are assuming more responsibility in triage or as nurse practitioners 6
Importance of Repeat Examinations
Repeat physical examinations by an experienced surgeon are crucial in the management of blunt abdominal trauma, as peritoneal signs may be subtle or masked by other factors 5 Serial ultrasounds can help evaluate patients with abdominal trauma, and future studies should investigate the utility of serial sonographic examinations 2