Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Department for General-, Visceral- and Thoracic-Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3575-3589. doi: 10.1007/s00068-020-01405-1. Epub 2020 Jun 23.
Physical examination, laboratory tests, ultrasound, conventional radiography, multislice computed tomography (MSCT), and diagnostic laparoscopy are used for diagnosing blunt abdominal trauma. In this article, we investigate and evaluate the usefulness and limitations of various diagnostic modalities on the basis of a comprehensive review of the literature.
We searched commonly used databases in order to obtain information about the aforementioned diagnostic modalities. Relevant articles were included in the literature review. On the basis of the results of our comprehensive analysis of the literature and a current case, we offer a diagnostic algorithm.
A total of 86 studies were included in the review. Ecchymosis of the abdominal wall (seat belt sign) is a clinical sign that has a high predictive value. Laboratory values such as those for haematocrit, haemoglobin, base excess or deficit, and international normalised ratio (INR) are prognostic parameters that are useful in guiding therapy. Extended focused assessment with sonography for trauma (eFAST) has become a well established component of the trauma room algorithm but is of limited usefulness in the diagnosis of blunt abdominal trauma. Compared with all other diagnostic modalities, MSCT has the highest sensitivity and specificity. Diagnostic laparoscopy is an invasive technique that may also serve as a therapeutic tool and is particularly suited for haemodynamically stable patients with suspected hollow viscus injuries.
MSCT is the gold standard diagnostic modality for blunt abdominal trauma because of its high sensitivity and specificity in detecting relevant intra-abdominal injuries. In many cases, however, clinical, laboratory and imaging findings must be interpreted jointly for an adequate evaluation of a patient's injuries and for treatment planning since these data supplement and complement one another. Patients with blunt abdominal trauma should be admitted for clinical observation over a minimum period of 24 h since there is no investigation that can reliably rule out intra-abdominal injuries.
体格检查、实验室检查、超声、常规 X 线摄影、多层螺旋 CT（MSCT）和诊断性腹腔镜检查用于诊断钝性腹部创伤。在本文中，我们基于对文献的全面回顾，研究和评估了各种诊断方式的实用性和局限性。
我们检索了常用数据库，以获取有关上述诊断方式的信息。将相关文章纳入文献综述。根据我们对文献的全面分析结果和一个当前病例，我们提出了一种诊断算法。
共有 86 项研究纳入了综述。腹壁瘀斑（安全带征）是一种具有高预测价值的临床征象。实验室值，如血细胞比容、血红蛋白、碱剩余或不足、国际标准化比值（INR），是有助于指导治疗的预后参数。扩展经胸超声检查（eFAST）已成为创伤室算法中的一个重要组成部分，但在诊断钝性腹部创伤方面的作用有限。与所有其他诊断方式相比，MSCT 的敏感性和特异性最高。诊断性腹腔镜检查是一种有创技术，也可用作治疗工具，特别适用于疑似空腔脏器损伤且血流动力学稳定的患者。
MSCT 是钝性腹部创伤的金标准诊断方式，因为其在检测相关腹部损伤方面具有较高的敏感性和特异性。然而，在许多情况下，临床、实验室和影像学发现必须联合解释，以便充分评估患者的损伤情况并制定治疗计划，因为这些数据相互补充。钝性腹部创伤患者应入院进行至少 24 小时的临床观察，因为没有任何检查可以可靠地排除腹部内损伤。
