Physical Examination

The abdomen should be examined for outward signs of injury such as abrasions or contusions to the abdominal wall. This should include the flank, back, and lower chest, as well as the anterior abdominal wall.

Physical examination is insensitive, as discussed earlier. In addition, injuries suspected on physical examination may be insignificant and require no therapy. Overall, if care depends on information gathered only by physical examination, care may be inappropriate up to 50 percent of the time.

Comprehensive serial physical examinations may be an acceptable method for identifying intraabdominal injury. These must be performed by the same senior-level clinician and should span a period of time of at least 16 to 24 h. The patient must be reliable and not have a condition where sensorium is altered. While there is little science describing this technique, we believe that physical examination must be performed at least every 30 minutes for the first 4 h and then hourly for an additional 4 to 6 h and every 2 to 4 h for the remainder of the 24-h observation period. This should be accompanied by frequent hematocrit determinations and measurement of serial vital signs. While this may be a rational technique in patients in a 23-h observation unit or in relatively quiet emergency departments that do not see a large volume of trauma, it is almost never applicable in high-volume centers that commonly see a multiplicity of injuries.

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