Background and Objectives: The purpose of this study was to determine the criteria which define the low risk patients after blunt ABDOMINAL trauma. It may hasten the patients handing and avoid unnecessary imaging and diagnostic. Considerations in low risk conditions.Materials and Methods: All adult patients referred to Imam Hussein hospital emergency department with blunt ABDOMINAL trauma and had signs and symptoms of intra-ABDOMINAL injury were enrolled to the study and followed for one-month. Collected data analyzed with Chi-square test. Sensitivity, specificity, positive and negative predictive value of each factor was calculated.Results: From total number of 205 enrolled patients (80% were male and 20% were female). The prevalence of three clinical factors (including’s hematuria, shock index above 0.8) and more clinical signs and symptoms at presentation were higher in patient with Intra-ABDOMINAL visceral injury than discharged patients (P<0.0001). Sensitivity, specificity, positive predictive value and negative predictive value of serious clinical presentation, hematuria, and shock index above 0.8 in the diagnosis of ABDOMINAL visceral injury were 100%, 45%, 100% and 17% respectively.Conclusion: This study showed that patients with low-risk criteria in blunt ABDOMINAL injury can be discharged without an abdominopelvic CT scan.

Objective: There has been a worldwide rise in the prevalence of penetrating ABDOMINAL injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating ABDOMINAL INJURIES and the treatment outcome in our center. Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20. 0. Results: There were 96 patients managed for ABDOMINAL INJURIES during the study period. Forty-six (47. 9%) of them had PAI, while 50 (52. 1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34. 2± 10. 8 years; median = 34 years). Majority, 42 (91. 3%), were males, while 4 (8. 7%) were females (M: F=11: 1). The most afflicted age group was in the 4th decade. Majority of the INJURIES were due to gunshot (60. 9%) followed by stab (26. 1%), unsafe abortion (6. 5%), road traffic injury (4. 3%) and fall (2. 2%). Gastrointestinal INJURIES were the most common with small bowel perforations predominating. Solid organ INJURIES were only seen in 3 (7. 9%) patients. Eight (17. 4%) had associated extra-ABDOMINAL INJURIES. Thirty-eight (82. 6%) patients required exploratory laparotomy, while 8 (17. 4%) were managed non-operatively. The negative laparotomy rate was 2. 6%. Seven (15. 2%) patients developed complications which were mostly wound infection (10. 8%). The duration of hospital stay was 1-58 days (mean 12. 7± 10. 5). Three patients (6. 5%) with gunshot INJURIES died. Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut INJURIES were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.

Background: Despite advances in the treatment of ABDOMINAL INJURIES in patients with trauma, it remains a major public health problem worldwide. Evaluation of hazard ratio (HR) of 90-day mortality in intensive care unit (ICU) patients with ABDOMINAL INJURIES compare with head INJURIES in trauma patients and non-trauma surgical ICU patients. Methods: This single-center, prospective cohort study was conducted on 400 patients admitted to the ICU between 2018 and 2019 due to trauma or surgery in Hamadan, Iran. The main outcome was mortality at 90-day after ICU admission. Cox proportional hazards models were used to determine the HR and 95% confidence interval (CI) for 90-day mortality. Results: The 90-day mortality was 21. 9% in ABDOMINAL INJURIES patients. According to multivariate Cox regression, the expected hazard mortality was 2. 758 times higher in patients with ABDOMINAL INJURIES compared to non-trauma patients (HR: 2. 758, 95% CI: 1. 077– 7. 063, P = 0. 034). About more than 50% of all deaths in the ABDOMINAL and head trauma groups occurred within 20 days after admission. Mean time to death was 27. 85 ± 20. 1, 30. 27 ± 18. 22 and 31. 43 ± 26. 24 days for ABDOMINAL-trauma, surgical-ICU, and head-trauma groups, respectively. Conclusion: Difficulty in accurate diagnosis due to the complex physiological variability of ABDOMINAL trauma, less obvious clinical symptoms in blunt ABDOMINAL INJURIES, multi-organ dysfunction in ABDOMINAL INJURIES, failure to provide timely acute care, as well as different treatment methods all account for the high 90-day mortality rate in ABDOMINAL-trauma patients. Therefore, these patients need a multidisciplinary team to care for them both in the ICU and afterwards in the general ward.

To the Editor-in-Chief We read with interest Chardouli et al. ’, s paper entitled “, A review on using ultrasound for evaluation of pediatric blunt ABDOMINAL trauma”,(1) and enjoyed it a lot. Now, we intend to add some of the results of our registry to their invaluable article. The National Trauma Registry of Iran was launched in 2016 at Sina Trauma and Surgery Research Center (2), and 24 different hospitals from various provinces collaborated in this project. Happily, more than 32, 000 patients have been included so far, 4603 of which belong to Sina Hospital (3-5). Furthermore, ample evidence shows that blunt ABDOMINAL injury is one of the most common presentations in the emergency rooms (6). Hence, we analyzed our data to find the severity of blunt ABDOMINAL INJURIES compared to other INJURIES. Among 4603 patients, 208 people had blunt trauma, and 17 were in the ABDOMINAL region. The mean injury severity score (ISS) of patients with blunt ABDOMINAL INJURIES was 1. 5 (standard deviation (SD)=1. 1). Also, the mean ISS of patients with ABDOMINAL INJURIES with other mechanisms (other than blunt traumas) was 3. 3 (SD=2. 5). The difference was statistically significant (P=0. 005) (Table 1). Moreover, the median of ISS among patients with blunt ABDOMINAL INJURIES was 1. 0 (interquartile range (IQR)=0. 0). Also, the median of ISS among patients with ABDOMINAL INJURIES with other mechanisms was 4. 0 (IQR=3. 0) (Table 1). All in all, our results show that if INJURIES are classified into two body regions of ABDOMINAL and others, and two mechanisms of blunt and others, blunt ABDOMINAL INJURIES can be less severe than INJURIES caused by other mechanisms and in other body regions. Declarations Acknowledgments None. Authors’,contribution All the authors met the standards of authorship based on the recommendations of the International Committee of Medical Journal Editors.

Background: Penetrating thoracoABDOMINAL stab wounds may cause diaphragmatic and ABDOMINAL organ laceration. However, 15-20% of these cases who are stable and managed by conservative treatment might have hidden diaphragmatic INJURIES, which could ultimately lead to chronic diaphragmatic hernia. Therefore, a safe and exact diagnostic method for the detection of occult diaphragmatic INJURIES is very valuable. In this study we have assessed the diagnostic value of thoracoscopy in occult diaphragmatic INJURIES resulting from penetrating thoracoABDOMINAL stab wounds. Methods: From March 2005 to October 2007, 30 hemodynamically stable patients with penetrating thoracoABDOMINAL INJURIES, not requiring emergent exploration, were enrolled in this study. All subjects underwent thoracoscopy to evaluate probable diaphragmatic injury. Diaphragmatic INJURIES were repaired via thoracoscopy or laparatomy. All patients were evaluated for chronic diaphragmatic hernia by CT-scan six months later.Results: The mean patient age was 26.2 years, with a male/female ratio of 5:1. Using thoracoscopic exploration, we observed five (16.7%) hidden diaphragmatic INJURIES, three (9.9%) of which were repaired using the thoracoscopic approach and two (6.6%) by laparatomy. Lung parenchymal laceration was seen in two patients (6.6%), for whom the repair was performed using thoracoscopy. Intra-ABDOMINAL injury was seen in one patient (3.3%), which was repaired by laparatomy. After thoracoscopy, there were no complications or evidence of chronic diaphragmatic hernia in the chest and ABDOMINAL CT-scans performed six months later. Therefore, the diagnostic accuracy of thoracoscopy in occult diaphragmatic INJURIES in our study was 100%. Conclusion: With its high degree of diagnostic accuracy, low degree of invasiveness, as well as its utility in treatment, we recommend thoracoscopy for all clinically stable patients with penetrating thoracoABDOMINAL stab wounds.

Background Currently, almost all patients with probable ABDOMINAL injury undergo urinalysis in emergency department (ED). The present survey was conducted with the aim of assessing the diagnostic values of urinalysis compare with ABDOMINAL computed tomography (CT) scan with contrast for predicting possible intra-ABDOMINAL INJURIES in children affected by blunt trauma. Materials and Methods: The present diagnostic accuracy study was accomplished on patients' < 16-year-old with blunt ABDOMINAL trauma who were admitted to emergency department (ED) and underwent both urinalysis and ABDOMINAL CT scan. Demographic and baseline characteristics data, and the results of urinalysis and ABDOMINAL CT scan were recorded. Thereafter, screening performance characteristics were calculated. Results Seventy eligible patients with the mean age of 7. 1 ± 4. 86 years were enrolled (68. 6% male). Screening performance characteristics including sensitivity, specificity and positive and negative predictive values of hematuria were 26. 7%, 92. 7%, 50. 0% and 82. 3%, respectively. Positive and negative likelihood ratios were calculated as 3. 67 and 0. 79, respectively. Conclusion It is likely that, presence of hematuria has acceptable specificity, but very low sensitivity in comparison with CT scan for prediction of ABDOMINAL organ INJURIES in children with blunt ABDOMINAL trauma. Therefore, urinalysis is not useful for screening the presence of organ INJURIES in this population.

Background and Objective: Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra ABDOMINAL organ injured more than others, related to mechanism of injury, size and location of organ in ABDOMINAL cavity. This study was carried out to determine the prevalence of intra ABDOMINAL INJURIES due to penetrating trauma.Materials and Methods: This retrospective descriptive study was done on 114 patients admitted to 5 Azar Hospital in Gorgan, Iran due to penetrating ABDOMINAL trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitalization period were obtained from patients files.Results: 92.1% of patients were male. The mean age of subjects was 24.8 years (9-70 years) with highest frequency between 20-24 years. Two (1.8%) deaths directly related to ABDOMINAL stab wounds related to hemorrhagic shock. The most common cause of penetrating ABDOMINAL injury was knife wound (78.9%). The mean time spent in hospital was 4.6±2.8 days. In 53 patients, cause of trauma was either related to penetration into peritoneum or passing through in. Small intestine INJURIES (14 %), rupture of diaphragm and concurrent lung INJURIES (7%) were the common damage organs.Conclusion: This study showed that the knife was the main cause of ABDOMINAL penetrates trauma and peritoneum was the most common damage tissue.

Background and Aim: ABDOMINAL Trauma seems to be one of the most common etiological factors of mortality in human populations following encountering different types of trauma. This study was designed to evaluate the role of sonography in clinical diagnosis of internal INJURIES of abdomen as well as verification and confirmation of the presence of free liquids in the ABDOMINAL cavity. This study was conducted to compare the importance of the role of sonography results with the clinical trend of trauma, specially the results of surgical operations in the studied cases.Materials and Methods: The present periodic study was conducted on all 104 patients (80 males and 24 females) who referred to Ali-ibne Abitaleb Hospital of Rafsanjan due to penetrating and blunt ABDOMINAL trauma between January 2000 and April2001. Personal characteristics of the patients such as age, cause of trauma, nature of the problem( fixed or temporary), clinical examination result, sonography result, laparatomy result-if done-, and the final diagnosis were recorded. Then, positive and negative results of sonography were matched with those of laparotomy and clinical trend. Finally, the obtained data was analyzed by EPI-5 software using Chi-Square Test at the significant level of P= 0.05.Results: Totally, sonography was done on 104 patients with ABDOMINAL trauma, who had homeodynamic status. Presence of free fluid in the ABDOMINAL cavities of some patients, as well as possible visceral lesions and gross pathologic changes of ABDOMINAL organs were recorded. Besides, sonography findings were negative in 85 patients (81.7%); and positive in 19 cases (18.3%). After comparing sonography findings with those coincident with surgery sonography accuracy and specificity were determined 85% and 65%, respectively.Conclusion: The results of this study generally support the role of sonography as one of the primary diagnostic techniques in the patients who are affected by ABDOMINAL trauma and have constant vital clinical signs. However, in order to make decision for laparatomy and surgical treatment, physical examinations, clinical observations and using other diagnostic techniques such as CT-Scan is imperative and can be helpful.

Background & Aims: Increase in ABDOMINAL pressure can lead to the so-called intra–ABDOMINAL compartment syndrome (ACS) that is often observed during the first 24 hours after sever ABDOMINAL trauma and surgery. Measurement of the intra ABDOMINAL pressure through the bladder as a non-invasive measurement can provide a quick and accurate assessment of ABDOMINAL pressure changes. This study was performed to compare the diagnostic value of intra-ABDOMINAL pressure measurement through the bladder with that of physical exam in the diagnosis of surgery indication.Methods: This descriptive- analytical study was performed on patients with intra-ABDOMINAL compartment syndrome due to blunt ABDOMINAL trauma referred to Nemazee hospital, Shiraz, Iran. Tools for data collection included a check list consisting demographic information, and intra-ABDOMINAL pressure measurement instruments. Data analysis was done through SPSS software.Results: Of 100 patients with ABDOMINAL trauma whose ABDOMINAL pressures were measured, 28 ones had ABDOMINAL compartment syndrome of whom, 21 ones (75 percent) were referred to the operation room by physician. Among all patients who were sent to the surgery room, 5 patients (23.80%) were survived and all those who were not sent to the surgery room died. Mean diagnosis time of measuring ABDOMINAL pressure for detection of operation indication was significantly lower than that of physical exam (P<0.01). Age, sex, type of trauma and type of injury to internal organ had no significant relationship with the rate of ABDOMINAL compartment syndrome. Also, there was no significant difference between the two methods in finding surgery indication. Conclusion: Implementing education on methods of early diagnosis of intra-ABDOMINAL pressure increase for medical team especially nurses is one of the treatment priorities.

Introduction: Prevalence of ABDOMINAL trauma is increasing during recent years. Abdomen is the third most affected part of body by trauma. Early diagnosis can help us select better methods for managing ABDOMINAL trauma. Even though newer imaging techniques such as CT scan are available, ABDOMINAL trauma is still a complex matter, which every doctor in the emergency department has to deal with. Physical examination for the evaluation of intra ABDOMINAL organ damage though impotant, is not enough. Material and Methods: This observational (cross-sectional) study was done over a period of 24 months (1999-2001). 135 patients (99male and 36 female) with ABDOMINAL trauma and no urgent laparotomy indication were included in this study. We calculated the sensitivity, specificity, positive&negative predictive values of DPL test in our cases using SPSS software. Results: Mean age of patients was 28.6 years. All of the patients were evaluated with peritoneal lavage which resulted in 70 positive and 65 negative cases. All of the 70 cases with positive results were further evaluated with laparotomy of which 63 cases have intra peritoneal INJURIES that needed surgical treatment, while 7 cases didnt have any intra peritoneal INJURIES (False positive results). All cases with negative results of peritoneal lavage test were treated conservatively for 3-5 days and during this period of time, 3 cases needed laparotomy and surgical treatment (False negative results). Conclusion : According to the results of this study, sensitivity of peritoneal lavage test in diagnosis of ABDOMINAL trauma was 95.5% and specificity was 90%. Negative predictive value of this test was 95.4% and positive predictive value of this test was 90%. Thus, peritoneal lavage test in ABDOMINAL trauma is sensitive, specific and has high specificity. It is therefore advisable that after initial evaluation of all penetrating and blunt ABDOMINAL traumas, peritoneal lavage test should be performed.