Clinical Profile and Outcome of Blunt Abdominal Trauma at a Rural Tertiary Care Centre in Andhra Pradesh: A Prospective Observational Study

Abstract

Background: Blunt abdominal trauma (BAT) is a major contributor to morbidity and mortality in patients presenting to emergency department and inexpensive, reliable tools for rapid triage are particularly valuable in resource-limited rural settings.

Objectives: To describe the clinical profile and outcome of patients with BAT at a rural tertiary care centre, to determine the frequency of a positive Extended Focused Assessment with Sonography in Trauma (E-FAST), and to assess the utility of the Clinical Abdominal Scoring System (CASS) in predicting the need for laparotomy.

Methods: A prospective observational study was conducted over 22 months in the Department of General Surgery at a tertiary care hospital in Kuppam, Andhra Pradesh. Thirty-nine patients aged 18-70 years with BAT were enrolled by purposive sampling. Clinical, laboratory and E-FAST findings were recorded on a structured proforma incorporating CASS, and data were analysed using SPSS version 26.0.

Results: The cohort was predominantly male (71.8%) with a mean age of 37.8 years; road traffic accidents accounted for 71.8% of injuries. E-FAST was positive in 94.9% of patients. Liver and splenic injuries were each present in 25.6% of cases. Conservative management succeeded in all 23 patients selected for it, with zero mortality, whereas 16 patients required surgery, among whom mortality was 25.0%. Overall mortality was 10.3%, and alcohol intoxication was associated with a 7.6-fold higher mortality (27.3% vs 3.6%). All patients with a CASS score ≥12 required laparotomy, whereas none with a score of 9 did.

Conclusion: Selective non-operative management guided by CASS and E-FAST achieved excellent outcomes in this rural cohort, and alcohol intoxication emerged as a key modifiable risk factor for mortality.