【Abstract】 Objectives: Trauma is among the lead-
ing causes of death. Medical management of blunt abdomi-
nal trauma (BAT) relies on judging patients for whom lap-
arotomy is mandatory. This study aimed to determine BAT
patients’ signs, as well as paraclinical data, and to clarify
the accuracy, sensitivity, specificity, positive and negative
predictive value of clinical abdominal scoring system
(CASS), a new scoring system based on clinical signs, in
predicting whether a BAT patient needs laparotomy or not.
Methods: Totally 400 patients suspected of BAT that
arrived at the emergency department of two university hos-
pitals in Tehran from March 20, 2007 to March 19, 2009 were
included in this study. They were evaluated for age, sex,
type of trauma, systolic blood pressure, Glasgow coma scale
(GCS), pulse rate, time of presentation after trauma, abdomi-
nal clinical findings, respiratory rate, temperature, hemoglo-
bin (Hb) concentration, focused abdominal sonography in
trauma (FAST) and CASS.
Results: Our measurements showed that CASS had
an accuracy of 94%, sensitivity of 100%, specificity of 88%,
positive predictive value of 90% and negative predictive
value of 100% in determining the necessity of laparotomy in
BAT patients. Moreover, in our analysis, systolic blood
pressure, GCS, pulse rate, Hb concentration, time of presen-
tation after trauma, abdominal clinical findings and FAST
were also shown to be helpful in confirming the need for
laparotomy (P<0.05).
Conclusion: CASS is a promising scoring system in
rapid detection of the need for laparotomy as well as in
minimizing auxiliary expense for further evaluation in BAT
patients, thus to promote the cost-benefit ratio and accu-
racy of diagnosis.
Key words: Abdominal injuries; Laparotomy;
Patients; Wounds, nonpenetrating