Practice management guidelines for the evaluation of blunt abdominal trauma: The EAST practice management guidelines work group

Injury to intra-abdominal viscera must be excluded in all victims of BAT. Physical examination remains the initial step in diagnosis but has limited utility under select circumstances. Thus, various diagnostic modalities have evolved to assist the trauma surgeon in the identification of abdominal injuries. The specific tests are selected on the basis of the clinical stability of the patient, the ability to obtain a reliable physical examination, and the provider's access to a particular modality. It is important to emphasize that many of the diagnostic tests used are complementary rather than exclusionary. On the basis of the above recommendations, a reasonable diagnostic approach to BAT is summarized in Figures 1 and 2. In hemodynamically stable patients with a reliable physical examination, clinical findings may be used to select patients who may be safely observed. In the absence of a reliable physical examination, the main diagnostic choice is between CT scanning or FAST (with CT scanning in a complementary role). Hemodynamically unstable patients may be initially evaluated with FAST or DPL.