Abdominal trauma in the emergency department; systematic review

Abstract

Background: Abdominal trauma is a major contributor to preventable morbidity and mortality. Decision making in the emergency department centres on rapid risk stratification, selection for operative versus nonoperative management, and early identification of patients likely to require intensive care. This literature review synthesizes articles describing patterns of abdominal injury, predictors of adverse outcomes and ICU utilization, and contemporary selective nonoperative management (SNOM) strategies for penetrating trauma. Methods: A narrative literature review was performed using the PubMed Central (PMC) full text archive. Searches combined terms for abdominal trauma, blunt injury, penetrating injury, intensive care, outcomes, and nonoperative management. Inclusion was restricted to peer-reviewed full text clinical studies reporting patient characteristics and outcomes for abdominal trauma. Key data were extracted from abstracts and results sections, and short verbatim quotations were used sparingly to preserve accuracy. Results: Five studies were synthesised: two large retrospective registry analyses describing epidemiology and outcome predictors for abdominal injury, one prospective protocol-driven study evaluating SNOM for penetrating solid organ injuries, and two retrospective cohorts evaluating SNOM pathways for penetrating abdominal trauma in different health-system contexts. Blunt mechanisms predominated in many settings and were accompanied by extra-abdominal injuries and physiologic derangement, which correlated with ICU admission and mortality. For penetrating trauma, SNOM was feasible in carefully selected haemodynamically stable, nonperitonitic patients using CT imaging and serial examinations, with low failure rates reported in protocolled settings. Conclusion: Our findings supports a physiology and imaging driven approach to abdominal trauma triage. ICU need is strongly linked to global injury severity, associated injuries, and early physiologic markers. For selected penetrating injuries, SNOM can reduce unnecessary laparotomy while maintaining acceptable safety when supported by structured protocols, CT imaging, and close observation.