1. BAT

2. Epidemiology BAT accounts for 80% of the abdominal trauma
75% related to RTC
Blows to abdomen and falls - 15% & 6-9%
Prevalence is 13%
Spleen & Liver most commonly injured

3. Mechanism of Injury
Intra-abdominal pressure outward can rupture a hollow vis
Lap belt without a shoulder attachment compresses the abd
Force against the anterior abd wall can lead to vertebral injury
Deceleration injuries can cause hollow Vis, tear vascular pedicle - kidney commonly injured
Fracture of ribs or pelvic bone can lacerate intra-abdominal tissues

4. History Fatality at scene Vehicle type & speed
Vehicle rolled over (seat position of impact )
Extent of intrusion ( >6 inches ass with increased injury)
Extent of damage to the vehicle
Steering wheel deformity
Seat belt used if so what type
Airbags

5. Examination Seat Belt sign (LR 5.6-9.9) Rebound tenderness ( LR 6.5)
Hypotension (LR 5.2)
Abdominal distension (LR 3.8)
Abdominal Guarding ( LR 3.7)
Femur fracture (LR 2.9)
10% with isolated HI may have abdominal injury
7% with no pain or tenderness but has distracting injury may have AT

6. Examination
Pain in the left costal margin is associated with splenic injury in 5.6%
90% of Patients with visceral injury with no distracting injuries will present with pain and tenderness
Awake, no distracting injury no findings on abdominal examination very unlikely to have any abdominal injuries
Think about referred pain
Seat belt sign - 1/3 will have abdominal injury

7. Lab test Haematocrit - <30% increase Likely hood (LR 3.3)
Leucocyte count
Pancreatic enzyme
LFT - Raised LT (LR )
Urine analysis - Microscopic H (LR )
Base deficit & lactate - BE of -6 was ass with intra-intra- abd injury & need for laparotomy & transfusion

8. CT Sensitivity & Specificity- 97-98% & 97-99%
Pt with BAT & negative MDCT - chances of injury low (0.06%) LR 0.034
In a study of 5000 pts only 5% had injury which needed surgery

9. US/Angio/DPL

10. Management Haemodynamically unstable patient
Hamedynamically Stable patient

11. Indication for Laparotomy
Unexplained blood loss or hypotension who cannot be stabilised
Persistent signs of irritation
Evidence of pneumoperitoneum consistent with viscus rupture
Diaphragmatic rupture
GI bleed which is persistent

12. Special Consideration
Pelvic Fracture
Multiple system injury
Closed Head Injury
Transfers
Pregnant patient
Geriatric Patient