In the April 2011 issue of the Annals of Emergency Medicine, the American College of Emergency Physicians published a clinical policy focusing on critical issues in the emergency department evaluation of adult patients presenting with acute blunt abdominal trauma. This is a revision of a clinical policy on acute blunt abdominal trauma that was published in 2004.

This clinical policy can also be found on ACEP’s Web site (www.acep.org) and will be abstracted on the National Guideline Clearinghouse Web site (www.guidelines.gov).

This clinical policy takes an evidence-based approach to answering four frequently encountered questions related to emergency department decision making. Recommendations (Level A, B, or C) for patient management are provided based on the strength of evidence using the Clinical Policies Committee’s well-established methodology.

Level A recommendations represent patient management principles that reflect a high degree of clinical certainty. Level B recommendations represent patient management principles that reflect moderate clinical certainty. Level C recommendations represent other patient management strategies based on Class III studies or, in the absence of any adequate published literature, based on consensus of the members of the Clinical Policies Committee.

During development, expert review comments were received from physicians in the fields of emergency medicine, surgery, and radiology, and from members of the American College of Surgeons Committee on Trauma, the Society for Academic Emergency Medicine, ACEP’s Emergency Medical Services Committee, ACEP’s Emergency Ultrasound Section, ACEP’s Quality and Performance Committee, and ACEP’s Trauma and Injury Prevention Section. Their responses were used to further refine and enhance this policy; however, their responses did not imply endorsement of this clinical policy.

The management of blunt trauma has always presented a diagnostic challenge. The range of injuries that can occur, along with the dire consequences of missing a serious injury, has led to an increased use of diagnostic modalities such as CT scanning and ultrasound. Nowhere is this more apparent than with blunt abdominal trauma. Abdominal injuries will often have delayed presentation even when life-threatening organ damage is present. Specifically, bleeding from splenic and liver lacerations initially may be contained within the organ capsule. As bleeding progresses, the capsule can rupture and lead to rapid exsanguination.

The identification of life-threatening injuries is of utmost importance. New-generation CT scanners can readily identify even small injuries to solid organs. However, in recent years there has been increased focus on the long-term effects of the radiation exposure from CT scans. With this in mind, it is important to accurately identify those patients who would benefit from further diagnostic imaging and those who can be safely observed.