How can I differentiate between minor and life-threatening abdominal injuries in a trauma patient?

To differentiate between minor and life-threatening abdominal injuries in a trauma patient, focus on clinical assessment and signs of haemodynamic instability. Life-threatening abdominal injuries often present with haemodynamic instability such as hypotension, tachycardia, or signs of ongoing internal bleeding, which require urgent intervention including damage control surgery or interventional radiology for arterial haemorrhage control. Minor injuries typically lack these signs and may be managed conservatively with close monitoring.

Key clinical indicators of life-threatening abdominal injury include:

• Haemodynamic instability not responding to volume resuscitation, indicating the need for damage control surgery.
• Active arterial bleeding from solid organs (spleen, liver, kidney) or pelvis, which may require interventional radiology or surgery.
• Signs of ongoing blood loss or expanding haematoma.
• Use of focused clinical assessment tools such as eFAST ultrasound can aid diagnosis but a negative result does not exclude serious injury.

Minor abdominal injuries generally present without haemodynamic compromise and may have stable vital signs, no evidence of active bleeding, and no signs of peritonitis or organ damage on imaging.

In all cases, rapid assessment of airway, breathing, circulation, disability, and exposure (ABCDE) is essential to identify life-threatening conditions promptly and determine the need for urgent transfer to a major trauma centre.

This approach aligns with NICE guidelines on major trauma assessment and management emphasizing clinical evaluation, haemodynamic status, and appropriate use of imaging and surgical interventions.