Grieshop et al proposed criteria for the performance of diagnostic peritoneal lavage (DPL) or abdominal CT in patients with blunt trauma to the abdomen. Beck et al expanded upon these criteria based on their analysis of patients with blunt trauma.
Grieshop recognized 3 levels of priority in patient management:
(1) Priority I - intra-abdominal hemorrhage requiring urgent surgery
(2) Priority II - other trauma potentially requiring surgical intervention
(3) Priority III - injuries amenable to observation
Priority
Evaluation
Action
I
DPL
laparotomy if abnormal, else observe
II
CT or DPL
laparotomy or non-operative management if abnormal, else observe
Original criteria of Grieshop et al for Priority I evaluation:
(1) hypotension (systolic blood pressure < 90 mm Hg)
Original criteria of Grieshop et al for Priority II evaluation - one or more of the following:
(1) abnormal abdominal physical examination
(2) chest injury
(3) gross hematuria
(4) Glasgow coma score (GCS) < 11
(5) spinal cord injury
(6) need for general anesthesia
Additional criteria of Beck et al for Priority II evaluation:
(1) need for intubation
(2) abnormal pelvic X-ray
If the patient had a normal abdominal examination and no Priority I or II criteria then the patient could be safely observed (Priority III).
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