Diagnosis of closed abdominal trauma in polytrauma: comparison of methods, Діагностика закритої травми живота при політравмі: порівняння методів

<jats:p>Background. Blunt abdominal trauma in polytrauma patients remains diagnostically challenging due to hemodynamic instability, depressed consciousness and combined injuries. An additional risk is associated with delayed recognition of bowel, mesenteric or retroperitoneal injuries. The purpose was to compare the diagnostic performance of clinical examination, initial Focused Assessment with Sonography for Trauma (FAST), serial FAST, contrast-enhanced multidetector computed tomography (CT) and an integrated algorithm for detecting clinically significant blunt abdominal injury in adult polytrauma patients. Materials and methods. A retrospective diagnostic study included 184 adults aged 18–79 years with blunt trauma and Injury Severity Score ≥ 16. The reference standard was operative verification or a concordant clinical-radiological diagnosis after 72-hour observation, repeat CT, angiographic intervention or surgery. Sensitivity, specificity, predictive values, accuracy and 95% confidence intervals (CI) were calculated. Predictors of delayed diagnosis were assessed using multivariable logistic regression. Results. Clinically significant intra-abdominal injury was identified in 72 of 184 patients (39.1 %). Therapeutically significant injury was found in 38 patients (20.7 %). Initial FAST showed 69.4 % sensitivity and 91.1 % specificity. Serial FAST demonstrated 80.6 % sensitivity and 89.3 % specificity. Contrast-enhanced CT showed 94.4 % sensitivity and 95.5 % specificity. The combined algorithm had 97.2 % sensitivity and 92.9 % specificity. Early contrast-enhanced CT/whole-body CT reduced the median time to definitive diagnosis from 88 to 49 min (p &lt; 0.001). Missed or delayed diagnosed injuries decreased from 10.5 to 2.0 % (p = 0.018). Negative initial FAST with lactate &gt; 2.5 mmol/L independently predicted diagnostic delay (odds ratio = 3.90; 95% CI 1.44–10.56; p = 0.008). Conclusions. FAST is useful for early triage but is insufficient as a stand-alone exclusion test in blunt abdominal trauma. Early contrast-enhanced CT provides the highest diagnostic yield in stable or stabilized patients. An integrated algorithm had additional value, it combines clinical, laboratory and ultrasound signs. Future studies should prospectively validate the proposed algorithm in multicenter trauma cohorts. A group of patients with negative FAST and laboratory markers of hypoperfusion requires a separate study.</jats:p>