Ferrera P C, Verdile V P, Bartfield J M, Snyder H S, Salluzzo R F
Department of Emergency Medicine, Albany Medical Center, NY 12208, USA.
Am J Emerg Med. 1998 Mar;16(2):145-9. doi: 10.1016/s0735-6757(98)90032-8.
While most conscious patients with severe intraabdominal injuries (IAI) will usually present with either abdominal pain or tenderness, there is a small group of awake and alert patients in whom the physical examination will be falsely negative because of the presence of associated extraabdominal ("distracting") injuries. We sought to define the types of extraabdominal injuries that could lead to a false negative physical examination for potentially severe IAI in adult victims of blunt trauma. This study was prospectively performed on consecutive blunt trauma patients over a 14-month period in our level I trauma center. Inclusion criteria were as follows: (1) Glasgow Coma Scale score of 15; (2) age 18 years or older; and (3) computed tomography (CT) of the abdomen or diagnostic peritoneal lavage (DPL) performed regardless of initial physical examination findings. Patients were questioned specifically about the presence of abdominal pain and the initial abdominal examination was documented in addition to other extraabdominal injuries. Abdominal injuries were considered to be present based upon either abdominal CT findings or a positive DPL. Patients with and without abdominal pain or tenderness were compared for the presence of IAI. A total of 350 patients were enrolled. There were 142 patients with neither abdominal pain nor tenderness (group 1) and 208 patients with either or both (group 2). Ten of the 142 patients (7.0%) in group 1 had IAI compared with 44 of the 208 patients (21.2%) in group 2 (P = .0003). Presence of pain and/or tenderness had a sensitivity of 82%, a specificity of 45%, a positive predictive value of 21%, and negative predictive value of 93%. All 10 patients in group 1, and 36 of the 44 group 2 patients, had associated extraabdominal injuries. Although the presence of abdominal pain or tenderness was associated with a significantly higher incidence of IAI, the lack of these findings did not preclude IAI.
虽然大多数意识清醒的严重腹部损伤（IAI）患者通常会出现腹痛或压痛，但有一小部分清醒且警觉的患者，由于存在相关的腹部外（“分散注意力的”）损伤，体格检查结果会出现假阴性。我们试图确定在钝性创伤成年受害者中，哪些类型的腹部外损伤可能导致对潜在严重IAI的体格检查出现假阴性。本研究在我们的一级创伤中心对连续14个月的钝性创伤患者进行了前瞻性研究。纳入标准如下：（1）格拉斯哥昏迷量表评分为15分；（2）年龄18岁或以上；（3）无论初始体格检查结果如何，均进行腹部计算机断层扫描（CT）或诊断性腹腔灌洗（DPL）。除了其他腹部外损伤外，还专门询问患者是否存在腹痛，并记录初始腹部检查情况。根据腹部CT结果或DPL阳性判断是否存在腹部损伤。比较有和没有腹痛或压痛的患者IAI的存在情况。共纳入350例患者。142例既无腹痛也无压痛的患者（第1组）和208例有腹痛或压痛其中之一或两者皆有的患者（第2组）。第1组142例患者中有10例（7.0%）存在IAI，而第2组208例患者中有44例（21.2%）存在IAI（P = 0.0003）。疼痛和/或压痛的敏感性为82%，特异性为45%，阳性预测值为21%，阴性预测值为93%。第1组的所有10例患者以及第2组44例患者中的36例都有相关的腹部外损伤。虽然腹痛或压痛的存在与IAI的发生率显著较高相关，但缺乏这些表现并不能排除IAI。
