BAT

Q: Which of the following has the highest likelihood ratio (LR) of Blunt Abdominal Trauma, popularly known as BAT? - select one

A) Abdominal distension 

B) Abdominal guarding

C) Hypotension  

D) Rebound tenderness 

E) Seatbelt sign

Answer: E

Of note, the most important pearl to remember during trauma evaluation of the abdomen is: "The absence of abdominal pain or tenderness does not rule out significant intra-abdominal injury."

A history and physical exam should be performed in detail. Interestingly, the seatbelt sign has the highest LR of probable underlying BAT. 

Seat Belt sign is followed by rebound tenderness, and in frequency down with hypotension, and abdominal distension. Abdominal guarding has the lowest LR in the above question for BAT.

Another important pearl to remember is that "the negative LR for the above signs, either alone or in combination, is low, which means that the absence of either sign does not exclude injury."

                                                     

Concomitant femur fracture can significantly distract the clinician from BAT, particularly in pedestrian trauma.

#trauma

References:

1. Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury? JAMA 2012; 307:1517.

2. Shreffler J, Smiley A, Schultz M, et al. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. J Emerg Med 2020; 59:491.

3. Pourmand A, Terrebonne E, Shapovalov V, et al. Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis. Am J Emerg Med 2024; 76:199.

4. Agrawal A, Inamadar PI, Subrahmanyam BV. Seat belt sign and its significance. J Family Med Prim Care. 2013 Jul;2(3):288-90. doi: 10.4103/2249-4863.120769. PMID: 24479100; PMCID: PMC3902689.