Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients?

OBJECTIVES

To determine the rate of elevated intra-abdominal pressure (IAP) and to evaluate the accuracy of clinical abdominal examination in the assessment of IAP in the critically injured trauma patient.

DESIGN

A prospective blinded study.

SETTING

The medical-surgical critical care unit of a university-affiliated regional adult trauma centre.

PATIENTS

Forty-two adult blunt trauma victims, who had a mean injury severity score of 36.

INTERVENTIONS

Urinary bladder pressure was measured daily and classified as normal (10 mm Hg or less), elevated (more than 10 mm Hg) or significantly elevated (more than 15 mm Hg). A blinded clinical assessment of abdominal pressure was concurrently performed and recorded as elevated or normal.

MAIN OUTCOME MEASURES

The sensitivity, specificity and accuracy and the positive and negative predictive values of the 2 interventions in identifying elevated IAP.

RESULTS

Twenty-one patients (50%) had an elevated IAP at some point during the study. Of the 147 bladder pressure measurements done in these 42 patients, 47 (32%) were more than 10 mm Hg and 16 (11%) were more than 15 mm Hg. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical abdominal examination for identifying elevated IAP were 40%, 94%, 76%, 77% and 77%, respectively. Clinical abdominal examination had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 56%, 87%, 35%, 94% and 84% respectively, for significantly elevated IAP.

CONCLUSIONS

Urinary bladder pressure was commonly elevated among our population of critically injured adults. Compared with bladder pressure measurements, clinical abdominal assessment showed poor sensitivity and accuracy for elevated IAP. These findings suggest that more routine measurements of bladder pressure in patients at risk for intra-abdominal hypertension should be performed.