For evaluating suspected abdominal injuries in adults, the recommended imaging modality is computed tomography (CT), particularly whole-body CT when blunt major trauma with suspected multiple injuries is present. This involves a vertex-to-toes scanogram followed by CT from vertex to mid-thigh without repositioning the patient, allowing comprehensive assessment including the abdomen NICE NG37.
CT is preferred as it provides rapid, detailed visualization of abdominal organs, vascular structures, and potential hemorrhage, which is critical in trauma settings NICE NG37. Focused assessment with sonography for trauma (FAST) may be used as an adjunct in haemodynamically unstable patients to quickly identify free fluid but should not replace CT for definitive diagnosis NICE NG37. A negative FAST does not exclude intra-abdominal or retroperitoneal bleeding NICE NG37.
Plain abdominal X-rays are generally not recommended for initial evaluation of abdominal trauma due to limited sensitivity and specificity NICE NG37. Magnetic resonance imaging (MRI) is not routinely used as a primary imaging modality in acute abdominal trauma due to logistical and safety concerns but may provide additional information in specific cases NICE NG37.
Recent literature supports the use of CT as the diagnostic gold standard for blunt abdominal trauma, emphasizing its high sensitivity and specificity for detecting solid organ injuries, vascular injuries, and active bleeding Achatz et al. 2022. Ultrasound-based FAST remains valuable for rapid bedside assessment but is limited by operator dependency and lower sensitivity for certain injuries Achatz et al. 2022. In renal trauma specifically, CT with contrast is the modality of choice to grade injury severity and guide management Dayal et al. 2013.
In summary, the integrated approach prioritizes whole-body CT scanning in adults with suspected abdominal injuries following blunt trauma, supplemented by FAST in unstable patients, while MRI and plain films have limited roles in the acute setting NICE NG37; Achatz et al. 2022; Dayal et al. 2013.
Key References
- NG37 - Fractures (complex): assessment and management
- NG232 - Head injury: assessment and early management
- NG41 - Spinal injury: assessment and initial management
- NG39 - Major trauma: assessment and initial management
- (Raissaki et al., 2011): Abdominal imaging in child abuse.
- (Dayal et al., 2013): Imaging in renal trauma.
- (Achatz et al., 2022): Diagnostic options for blunt abdominal trauma.