A haemoperitoneum does not indicate active bleeding in the peritoneum in 50% of hypotensive blunt trauma patients: A study of 110 severe trauma patients
Section snippets
Background
On admission of a patient with blunt exsanguinating trauma, the aim of initial management is to localise and control the active haemorrhage as soon as possible.1, 2 Rationally, in a patient with blunt trauma presenting haemodynamic instability associated with a free peritoneal effusion, the obvious source of exsanguination is the peritoneum. As a consequence, the Focus Assessment with Sonography for Trauma (FAST) is the pivotal diagnostic used to localise the source of bleeding and guide
Study design and patients
The database of 1079 patients admitted consecutively for trauma in the trauma intensive care unit at our level I Regional Trauma Centre between January 2005 and January 2010 was reviewed retrospectively. These patients were suspected for a severe trauma by a prehospital medical team (SAMU system) and were directly hospitalised in our trauma department according to the French guidelines of prehospital medical triage.6 All blunt trauma patients aged 16 years or over with a haemodynamic
Population characteristics and initial management (n = 110)
During this 5-year period, 115 patients admitted to our trauma department were diagnosed with a moderate or large haemoperitoneum associated with a systolic blood pressure lower than 90 mm Hg within the first 15 min after admission. Five patients died before exploration and were excluded because of a lack of data. Of the 110 remaining patients, 78 (71%) were male, mean age 35.3 (SD 19) years. Mechanisms of trauma were: a motor vehicle crash in 92 patients, 7 pedestrians struck by a motor vehicle,
Discussion
The main finding of our study is that in severe blunt trauma patients, the source of bleeding can be multiple. In this population of blunt trauma patients presenting hypotension and haemoperitoneum on admission, the clinical situation instinctively guides us to an active haemorrhage from a peritoneal source. However, only 52% of our hypotensive patients had PAB and 49% had an EPAB (Fig. 1). Therefore, why did so many patients in this caricatural clinical scenario have no PAB? Why so many
Conclusion
The half of hypotensive blunt trauma patients with haemoperitoneum on admission does not have AB of peritoneal origin. In severe blunt trauma patients, the source of bleeding can be multiple. In such cases, a haemoperitoneum may be confusing and mask the real origin of AB, causing delay in necessary haemostatic treatment, which may be life threatening. As expected, a large haemoperitoneum is strongly associated with the presence of PAB in bleeding patients, although 12% of large haemoperitoneum
Conflict of interest
The authors have no conflicts of interest to declare.
Acknowledgements
The authors wish to thank Sophie Bringuier and Dorine Neveu for their contributions to the statistical analysis of this study.
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