Evaluation of the abdomen in intoxicated patients: Is computed tomography scan or peritoneal lavage always indicated?

Study objective: To investigate the necessity of intensive evaluation of the intoxicated patient with normal mentation for intra-abdominal injury after blunt torso trauma. Design: Retrospective study; trauma registry and medical records. Setting: Level I regional trauma center serving a population of 2.3 million. Participants: Adult victims of blunt trauma more than 17 years old, admitted between January 1, 1986, and December 31, 1989, with suspected blunt abdominal injury and serum ethanol of more than 100 mg/dL and Glasgow Coma Score of 15. Intervention: All patients had serum ethanol levels measured in mg/dL and computed tomography (CT) scan of the abdomen and/or diagnostic peritoneal lavage (DPL). Results: Criteria were met by 92 patients. Eighty-nine underwent CT scans, two had DPL, and one had both. Of 17 patients complaining of abdominal pain and/or tenderness on palpation, six (35.3%) had blood in the peritoneal cavity demonstrated by CT scan or DPL and underwent celiotomy All 75 patients without abdominal pain or tenderness had negative CT scan or DPL, with no missed injury. Conclusion: In the intoxicated blunt trauma patient with normal mentation, the physical examination is a reliable indicator of abdominal injury. Elevated alcohol level; per se, should not be considered an absolute indication for DPL or abdominal CT.