Blunt Abdominal Solid Organ Injury Clinical Pathway — Emergency Department, Inpatient and ICU

History and Physical

Review of history, physical exam, labs, and imaging may help clinicians determine need for further diagnostic imaging.

History	Mechanism of Injury (MOI) High energy Unrestrained or improperly restrained occupant in MVC Pedestrian or bicyclist vs. Auto Large distance falls Blunt impact to abdomen, flank, back Abdominal pain after injury Emesis after injury
Physical Exam	Abdominal tenderness Particularly diffuse or upper abdomen Abdominal distention Abdominal wall ecchymosis or abrasions (Including seat belt sign) Hematuria Distracting injury GCS < 13 with concerning MOI Signs of hemorrhagic shock Tachycardia, poor perfusion Waxing, waning mental status Hypotension = Late sign	Increasing degrees of abdominal tenderness are associated with increased risk of injury Limitation: Sensitivity of pain and tenderness decreases as GCS decreases

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Blunt Abdominal Solid Organ Injury Clinical Pathway — Emergency Department, Inpatient and ICU

History and Physical

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Abdominal Injury — History and Physical — Clinical Pathway: Emergency Department, Inpatient, and ICU

Blunt Abdominal Solid Organ Injury Clinical Pathway — Emergency Department, Inpatient and ICU

History and Physical