Blunt Abdominal Trauma
Patient with mechanism concerning for abdominal injury
All Pathways
Trauma SurgeryDiagnostic
Blunt Abdominal Trauma Evaluation
Blunt Abdominal Trauma Evaluation: Blunt Abdominal Trauma → Primary Survey Complete → Hemodynamic Status? → FAST Exam (Unstable) → FAST Positive + Unsta...
Pathway Overview
15 steps
Algorithm Steps
15 total
01Start 02Action Primary Survey Complete
ATLS primary survey with life threats addressed
- Airway, breathing secured
- IV access, blood availability
- Baseline mental status documented
03Decision Hemodynamic Status?
Assess stability for workup
- Stable: SBP ≥90, HR <120, responding to fluids
- Unstable: SBP <90, tachycardia, altered mental status
- Transient responder: initial response then deteriorates
04Decision FAST Exam (Unstable)
Bedside ultrasound
- Morison's pouch (RUQ)
- Splenorenal recess (LUQ)
- Pelvis (pouch of Douglas)
- Pericardium
05Warning FAST Positive + Unstable
IMMEDIATE Laparotomy
- No CT - patient too unstable
- Emergent exploratory laparotomy
- Activate OR, notify trauma surgery
- Continue resuscitation en route
06Outcome Injury Managed
Continue monitoring, plan disposition
07Action FAST Negative + Unstable
Look for other sources
- Chest: hemothorax? CXR/chest tube
- Pelvis: pelvic XR, binder
- Long bones: examine, splint
- Repeat FAST (operator dependent)
- Consider DPL if FAST equivocal
08Action CT Abdomen/Pelvis
For hemodynamically stable patients
- CT with IV contrast (portal venous phase)
- Oral contrast not routinely needed
- Can combine with CT chest, head
- Characterize solid organ injuries
- Identify free fluid, extravasation
09Decision CT Findings
Injury identified?
10Action Solid Organ Injury (Liver/Spleen)
Grade injury, assess for NOM
- Grade by AAST scale
- Stable: Non-operative management (NOM)
- Active extravasation: Consider angioembolization
- High-grade + hemodynamic concern: Consider OR
11Action NOM Criteria
Non-operative management
- Hemodynamically stable
- No peritonitis
- No hollow viscus injury
- Blood products available
- ICU monitoring capability
- Surgical backup available 24/7
12Action NOM Monitoring
Serial assessment protocol
- ICU admission for high-grade injuries
- Serial abdominal exams q4-6h
- Serial hematocrits
- Repeat CT if clinical deterioration
- Activity restrictions on discharge
- Path rejoins step 06Shared downstream outcome
13Action Angioembolization
For active bleeding on CT
- Contrast blush on CT
- High-grade spleen/liver injury
- Stable enough for IR suite
- Consider if transfusion >2 units
- Path rejoins step 12Shared downstream outcome
14Warning Operative Management
Indications for surgery
- Hemodynamic instability despite resuscitation
- Peritonitis on exam
- Hollow viscus injury
- Failed NOM (ongoing transfusion, deterioration)
- High-grade injury without angio capability
- Path rejoins step 06Shared downstream outcome
15Warning Hollow Viscus Injury
Surgical exploration needed
- Free air: bowel perforation
- Mesenteric stranding, bowel wall thickening
- Delayed presentation common
- Operative exploration indicated
- Path rejoins step 14Shared downstream outcome
- Path rejoins step 12Shared downstream outcome
- Path rejoins step 08Shared downstream outcome
Guideline Source
EAST PMG + WTA Blunt Abdominal Trauma Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- FAST operator-dependent
- CT requires hemodynamic stability for transport
- Hollow viscus injury may be missed initially
- Serial exams recommended for equivocal findings
Applicable Regions
USEUGlobal
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Blunt Abdominal Trauma Evaluation?
The Blunt Abdominal Trauma Evaluation is a diagnostic clinical algorithm for Trauma Surgery. It provides a structured decision tree to guide clinical decision-making, based on EAST PMG + WTA Blunt Abdominal Trauma Guidelines.
What guideline is the Blunt Abdominal Trauma Evaluation based on?
This algorithm is based on EAST PMG + WTA Blunt Abdominal Trauma Guidelines (DOI: Multiple sources).
What are the limitations of the Blunt Abdominal Trauma Evaluation?
Known limitations include: FAST operator-dependent; CT requires hemodynamic stability for transport; Hollow viscus injury may be missed initially; Serial exams recommended for equivocal findings. Individual patient factors may require deviation from these recommendations.
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