Predictive parameters for early detection of clinically relevant abdominal trauma in multiple-injury or polytraumatised patients: a retrospective analysis

Abstract

Diagnosis of relevant organ injury after blunt abdominal injury (AI) in multiple-injury/polytraumatised patients is challenging. AI can be distinguished between injuries of parenchymatous organs (POI) of the upper abdomen (liver, spleen) and bowel and mesenteric injuries (BMI). Still, such injuries may be associated with delays in diagnosis and treatment. The present study aimed to verify laboratory parameters, imaging diagnostics, physical examination and related injuries to predict intraabdominal injuries. This retrospective, single-centre study includes data from multiple-injury/polytraumatised patients between 2005 and 2017. Two main groups were defined with relevant abdominal injury (AI⁺) and without abdominal injury (AI^-). The AI⁺ group was divided into three subgroups: BMI⁺, BMI⁺/POI⁺, and POI⁺. Groups were compared in a univariate analysis for significant differences. Logistic regression analysis was used to determine predictors for AI⁺, BMI⁺ and POI⁺. 26.3% (271 of 1032) of the included patients had an abdominal injury. Subgroups were composed of 4.7% (49 of 1032) BMI⁺, 4.7% (48 of 1032) BMI⁺/POI⁺ and 16.8% (174 of 1032) POI⁺. Pathological abdominal signs had a sensitivity of 48.7% and a specificity of 92.4% for AI⁺. Transaminases were significantly higher in cases of AI⁺. Pathological computed tomography (CT) (free fluid, parenchymal damage, Bowel Injury Prediction Score (BIPS), CT Grade > 4) was summarised and had a sensitivity of 94.8%, a specificity of 98%, positive predictive value (PPV) of 94.5% and, negative predictive value (NPV) of 98.2% for AI⁺. The detected predictors for AI⁺ were pathological abdominal findings (odds ratio (OR) 3.93), pathological multi-slice computed tomography (MSCT) (OR 668.9), alanine (ALAT) ≥ 1.23 µmol/ls (OR 2.35) and associated long bone fractures (OR 3.82). Pathological abdominal signs, pathological MSCT and lactate (LAC) levels ≥ 1.94 mmol/l could be calculated as significant risk factors for BMI⁺. For POI⁺ pathological abdominal MSCT, ASAT ≥ 1.73 µmol/ls and concomitant thoracic injuries had significant relevance. The study presents reliable risk factors for abdominal injury and its sub-entities. The predictors can be explained by the anatomy of the trunk and existing studies. Elevated transaminases predicted abdominal injury (AI⁺) and, specifically, the POI⁺. The pathological MSCT was the most reliable predictive parameter. However, it was essential to include further relevant parameters.

Keywords: Bowel and mesenteric injury; Computed tomography; Laboratory parameters; Parenchymatous injury; Polytrauma; Predictive parameters.