Factors Associated with Intra-abdominal Injury in Patients with Severe Traumatic Brain Injury

Prasan  Piamanan; parinya Tianwibool; Pavita Laohakul

Authors

Prasan Piamanan Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand
parinya Tianwibool Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-9643-8773
Pavita Laohakul Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-9925-3301

Keywords:

severe TBI, intra-abdominal injury, abdominal CT scan

Abstract

Objective To identify factors associated with intra-abdominal injuries in patients with severe traumatic brain injury (TBI) to increase the probability of identifying those injuries.

Methods After receiving Institutional Review Board approval, we conducted this retrospective study at Maharaj Nakorn Chiang Mai Hospital, a level-1 trauma center and university hospital. The records of all patients with severe TBI (Glasgow Coma Scale Score: GCS < 9) who visited the Emergency Department (ED) between July 2015 and September 2016 were included and reviewed. Factors found to be statis-tically significantly associated with intra-abdominal injury based on univariate analysis were analyzed using multivariate analysis. All data analyses was performed using SPSS software version 22.0.

Results Of the total of 194 patients who underwent routine abdominal CT scans following the institutional protocol, 23 had intra-abdominal injuries (11.86%). Factors found to be associated with positive abdominal CT scans, i.e., scans showing intra-abdominal injuries, using univariate logistic regression analysis include diastolic blood pressure (DBP), mean arterial pressure (MAP), low GCS (3-5), Shock Index ≥ 0.9, Focused Assessment with Sonography for Trauma (FAST) positive or signs of peritonitis, thoracic injury, and pelvic injuries (p < 0.05). Factors statistically significantly associated with intra-abdominal injury in multivariate logistic regression were GCS 3-5, FAST positive or signs of peritonitis, thoracic injury, and pelvic injuries.

Conclusions A routine abdominal CT scan in severe TBI patients can help detect injuries, even in patients with no significant abnormal physical examination and a negative FAST. Four factors associated with positive routine abdominal CT scans are GCS 3-5, positive FAST or signs of peritonitis, thoracic injury, and pelvic injury. A routine abdominal CT scan, however, does take additional time and adds more processes to the management of a trauma patient. A future cost-effective study of this issue is warranted.

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