Abdominal Injury — Labs and Imaging — Clinical Pathway: Emergency Department, Inpatient, and ICU

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

Labs and Imaging

Labs
  • CBC
  • LFTs
  • Amylase/Lipase
  • UA
 AST > 200 U/L and ALT > 125 U/L, UA w/ > 5 RBCs per high-powered field, and initial hematocrit < 30% are associated with
intra-abdominal injury.
Imaging Abdomen/Pelvis CT with IV Contrast
  • Abdomen/Pelvis CT with IV Contrast is the preferred modality for hemodynamically stable children. The addition of PO contrast does not improve detection of intra-abdominal injury and should be avoided unless directed by the Trauma Surgical team.
  • Note: Evaluation, including threshold to image, may change if there is suspicion for inflicted injury, ED Physical Abuse Pathway.
  • Contraindications to CT:
    • Hemodynamic instability
    • Injury requiring emergent procedures
    • Obvious signs of peritonitis or free air on plain radiograph of the abdomen
  • For renal injuries ≥ Grade III, obtain delayed cuts/imaging to evaluate for contrast extravasation indicating damage to the collecting system.
Chest XR An abnormal CXR has been found to be associated with
intra-abdominal injury.