Effectiveness of clinical abdominal scoring system in the management of patients with blunt trauma abdomen

Abstract

Background: Abdominal injury being the most common cause of mortality and morbidity, its incidence comes after extremities and head injury. Early diagnosis and treatment can reduce mortality by upto 50%. The common causes for blunt trauma abdomen include motor vehicle crashes, direct trauma and fall from heights. Objectives of the current investigation were to score the patients with BTA with clinical abdominal scoring system and to compare the score of CASS with USG/CT abdomen and pelvis findings in patients of BTA. Methods: All patients who are suspected to have BTA were scored using CASS and radiological investigations were done in the ED. The decision to proceed with the surgery would be done if the patient had CASS >12 and/or if the radiological investigation shows features of BTA like air under diaphragm or grade IV/V solid organ injury.Results: Males accounts for 81% of cases and the rest being females. Most common mode of injury was found to be RTA. Most common injured organs are spleen >liver >small intestine (ileum). The CASS has specificity of 84.62%, sensitivity of 99.2%, PPV 33.3%, NPV 100%. Total mortality in the study was 7.1%Conclusions: Patients with CASS of <8 can be managed conservatively. Patient with score >12 or hemodynamically unstable can be taken up for emergency laparotomy without any delay. Patients with CASS between 9 and 11, with good clinical assessment aided with radiological investigations can be managed depending upon the severity of the injury.

Evaluation of clinical abdominal scoring system for predicting outcomes of blunt abdominal trauma

“…(6) In our investigation, systolic blood pressure was 90-12 mmHg, >120 mmHg, and< 90 mmHg in 48 (60.0%), 13 (16.3%), and 19 (23.8%) patients, respectively. This is similar to the results of Kumar et al (7) , where the majority of subjects (22/30) had a systolic blood pressure between 90 and 120 mmHg, followed by >120 mmHg (6/30 subjects), and finally 90 mmHg (2/30 subjects). The Glasgow coma scale (GCS), which assesses the patient's consciousness, is the fourth criterion tested by the CASS.…”

“…Men prefer to be employed in professions that involve more mobility due to culture and traditions, and men additionally suffer more substance and alcohol abuse compared to women. (7) This seems congruent with data showing that 61% of cases of blunt abdominal trauma are from road accidents, while up to 25% are caused by falls from heights, and the other cases are due to other causes. (9) In order to determine whether patients with acute abdominal injuries require surgical treatments such as laparotomies, the clinical abdominal scoring system (CASS) has started to be utilized widely.…”

“…(3) Among the elements that significantly impact a patient's prognosis is the time of the patient's emergency room visit following a traumatic event. (7) Pursuant to our study, the time of presentation or the commencement of trauma was >6 hours in 43 (53.8%) of the subjects, followed by 2-6 hours in 28 (35%), and 2 hours in 9 (11.3) of the individuals. These findings are reinforced by a study by Kumar et al, (7) which revealed that only 16.7% of instances occurred within two hours of the trauma, whereas 26.2% occurred between two and six hours after the trauma, and 57.1% occurred within six hours.…”

“…(3,8) The findings of the present study contrast with those of other studies done in the past. During research conducted by Kumar et al, (7) specificity, sensitivity, PPV, and NPV were found to be 84.62%, 99.2%, 33.3%, and 100%, respectively. Another study showed the specificity, sensitivity, PPV, and NPV to be 88%, 100%, 90%, and 100%, respectively.…”

“…There were 21 (26.3%) female and 59 (73.8%) male participants. According to research by Kumar et al, (7) men may sustain blunt abdominal injuries in as much as 81% of cases, while women comprise the remaining 19%. A startling 38.1% of cases of blunt abdominal injuries occurs in individuals had GCS 13 to 15.…”