Effectiveness of clinical abdominal scoring system in the management of patients with blunt trauma abdomen
Keywords:CASS, BTA, USG abdomen and pelvis
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.
Peyman EA, Nima HN, Mojtaba C, Vafa RM. Evaluating clinical abdominal scoring system in predicting the necessity of laprotomy in blunt abdominal trauma. Chin J Trauma. 2011;14:156-60.
Ellis BW. Hamilton Bailey’s emergency surgery. 13th ed. New Delhi: Jaypee Publishers; 2012:446-71.
Nikhil M, Sudarshan B, Kumar V. An experience blunt abdominal trauma evaluation management and outcome. J clinics and practice. 2014;4:594-9.
Sinwar PD, Chouhan SP, Kajla RK. Evaluation and management of splenic injury in blunt trauma abdomen. Sch J App Med Sci. 2014;2:1565-8.
Smith JE, Hall EJ. The use of plain abdominal x-rays in the emergency department. Emerg Med J. 2009;26:160-3.
Singh SP, Gupta V, Singh SP, Verma R, Gupta P, Kumar A, et al. Pattern of injury of blunt trauma abdomen in rural population. Int J Surg. 2016;3:497-500.
Fleming S, Bird R, Ratnasingham K, Sarker SJ, Walsh M, Patel B. Accuracy of FAST scan in blunt abdominal trauma in a major London trauma center. Int J surg. 2012;10:470-4.
Homan G, Toschke C, Gassmann P, Vieth V. Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries. Chin J trauma. 2014;17:25-30.
Shojaee M, Faridaalae G, Yousefifard M, Yaseri M, Dolatabadi AA, Sazghabaei A, et al. New scoring system for intraabdominal injury diagnosis after blunt trauma. Chin J Trauma. 2014;17:19-24.
Rahman S. and Das P. A retrospective clinical study on blunt trauma abdomen and its management. Int Surg J. 2018;5(7):2582.
Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: evaluation, management and outcome. Clin Prac. 2014;4(2):59-64.
Yogesh V, Venkateswaran P, Rajkamal C. A study of blunt injury abdomen in patients attending the emergency department in a tertiary hospital. Int Surg J. 2016;2(5):153-7.
Singh S, Gupta V, Singh S, Verma R, Gupta P, Kumar A, et al. Pattern of injury of blunt trauma abdomen in rural population. Int Surg J. 2016; 3(7):497-500.
Srivastava SK, Jaiswal AK, Kumar D. Prospective study of management and outcome of blunt abdominal trauma (solid organs and hollow viscus injuries). Int Surg J. 2017;4(10):3262.
Vanitha TMS, Prasanth K. Prospective study comparing the clinical abdominal scoring system (Cass) with blunt abdominal trauma severity scoring (batss) in predicting the necessity of laparotomy. J Dent Med Sci. 2018;17(3):25-33.