Predicting Failure of Nonoperative Management Following Blunt Abdominal Trauma

 

Parameters:

(1) nonliver injury (usually injury to spleen, kidney)

(2) FAST results (focused abdominal sonography for trauma)

(3) need for blood transfusion

(4) amount of intra-abdominal fluid on CT scan

Parameter	Finding	Points
nonliver injury	absent	0
	present	1
FAST results	negative	0
	positive	1
need for blood transfusion	no	0
	yes	1
intra-abdominal fluid	<= 300 mL	0
	> 300 mL	1

 

X =

= (1.5620 * (points for nonliver injury)) + (1.2138 * (points for FAST)) + (2.568 * (points for blood transfusion)) + (1.6996 * (points for intra-abdominal fluid)) - 3.8622

 

odds of failure for nonoperative management =

= EXP(X)

 

probability of failure =

= 1 / (1 + (1 / (odds)))

 

where:

• The conversion of odds to probabilities is discussed in Chapter 39.

• The data in Table 3 shows "liver injury" while the equation uses "nonliver injury". To get the values shown in Table 3 from the equation, a "yes" for "liver injury" has to be entered as a "no" in the equation. It appears as if "liver injury" refers to liver injury only (no non-liver injury).

• In Table 4 (page 848) they show that no patients with blunt trauma limited to the liver failed nonoperative management. If the spleen only was injured, the failure was around 54%. If the kidney only was injured, the failure was 18%.