In patients with isolated blunt abdominal trauma, are there clinical predictors that allow the clinician to identify patients at low risk for adverse outcome who do not need an abdominal CT?

• Level A recommendations: None specified.
• Level B recommendations: None specified.
• Level C recommendations: Patients with isolated abdominal trauma for whom occult abdominal injury is being considered may not need abdominal CT scanning if the following are absent: abdominal tenderness, hypotension, altered mental status, costal margin tenderness, abnormal chest radiograph, hematocrit under 30%, and hematuria.

Comments: CT has become the criterion standard imaging study in high-risk patients with blunt abdominal injuries. However, there has been increased concern regarding long-term effects of radiation, especially in younger patients. Use of specific patient characteristics as defined by a clinical decision rule or variables shown to be independently associated with poor outcome may help guide imaging.

Ways to identify patients who do not require diagnostic imaging have not been adequately studied and should be a focus of further research.

This clinical policy is not intended to be generalized to multitrauma patients. The treating physician’s clinical judgment regarding the patient’s risk for serious injury should take precedence over any clinical decision rules.

Dr. Chenoweth is a resident physician in the Department of Emergency Medicine at the University of California, Davis Medical Center in Sacramento. Dr. Diercks is a Professor of Emergency Medicine at the University of California, Davis Medical Center, and is a member of ACEP’s Clinical Policies Committee.