Blunt force trauma

Last updated: October 5, 2022

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Blunt force trauma (BFT) is any nonpenetrating injury resulting from the impact of a blunt object against the body (e.g., a vehicle-pedestrian collision) or impact of the body against a blunt object or surface (e.g., a fall from height). Common causes include motor vehicle crashes, falls, and being struck by an object (e.g., sports injuries). Low-impact BFT can result in dermal contusions and/or abrasions that only require supportive treatment, whereas high-impact BFT, especially of the head, thorax, and abdomen can cause severe internal organ injury in addition to skin injury and represents a major cause of morbidity and mortality in all age groups. First response in severe BFT focuses on stabilizing vital signs, airway and circulation management. FAST and CT imaging are used to detect intraabdominal bleeding and organ damage, while chest x-ray is the most important initial diagnostic tool in the assessment of blunt force chest and abdominal trauma. Treatment depends on the hemodynamic status of the patient as well as the type of injury, which may require emergency surgery. Conservative management with close monitoring is indicated for hemodynamically stable patients.

For information on prehospital care and general principles of trauma management, see “Prehospital trauma care.” Penetrating trauma is discussed in a separate article.

Epidemiology [1]

Classification [1]

Mechanism of injury [1]

BFT typically results from the impact of a blunt object against the body or impact of the body against a blunt object or surface. The most common causes of BFT are motor vehicle crashes, vehicle-pedestrian collisions, falls from height, and bicycling injuries. [3]

Commonly affected systems [4]

The most commonly injured organs in blunt force abdominal trauma are the spleen (e.g., splenic rupture, laceration) and liver (e.g., liver hematoma, laceration).

Clinical features of abdominal bleeding [4]

Clinical features of commonly affected organs [4]

Management [4]

  • Diagnostic peritoneal lavage (DPL)
    • Performed by placing a catheter into the abdomen, aspirating, then instilling a warm saline.
    • This highly sensitive but invasive procedure is gradually being replaced by the rapid, noninvasive FAST exam.
    • Indications
      • Hemodynamically unstable patients if FAST is inconclusive
      • Hemodynamically unstable patients if FAST or CT cannot be performed

Approach to blunt abdominal trauma

Initial management of abdominal BFT is focused on stabilizing, identifying potential intraabdominal bleeding, and treating life-threatening injuries.

  • Prehospital trauma care
  • Initial assessment and examination
    • See “Clinical features of abdominal bleeding” above.
    • The absence of abdominal pain or tenderness does not exclude the presence of intraabdominal injuries.
  • Hemodynamically stable patients: initial risk assessment according to the mechanism of injury, physical examination (e.g., GCS, evidence of intoxication), and initial laboratory studies
    • If the patient is alert:
      • FAST scan
        • Negative findings of injury: serial examinations and additional tests (e.g., CT scan) if there is suspicion of injury
        • Positive findings of injury: abdominal CT scan
        • Inconclusive findings: laparotomy or DPL
      • Abdominal CT scan
        • Negative findings of injury: close monitoring
        • Positive findings of injury: close monitoring of vital signs or laparotomy
    • If the patient is not alert: perform abdominal CT scan and serial examinations
      • Positive findings of injury in abdominal CT scan: close monitoring of vital signs or laparotomy
      • Negative findings of injury in abdominal CT scan: serial examinations until the patient is alert
  • Hemodynamically unstable patients
    • FAST scan
      • Negative findings of injury: assess for additional signs of extraabdominal hemorrhage.
        • If negative signs of extraabdominal hemorrhage: resuscitate with fluids, stabilize, and perform abdominal CT scans.
        • If positive signs of extraabdominal hemorrhage: stabilize, resuscitate with fluids, and manage accordingly.
      • Positive findings of injury: laparotomy
    • DPL
  • According to specific injuries

If significant intraabdominal injury is suspected, imaging should be performed even in the absence of pain.

Common associated injuries

Clinical features

Approach to blunt chest trauma

Rib fracture

Phrenic nerve paralysis

Blunt cardiac injury (BCI) [5][6]

Aortic injury and traumatic rupture of the aorta (aortic rupture)

Pulmonary contusion

Tracheobronchial injury (TBI)

Pneumomediastinum [10]

Diaphragmatic rupture

  • Definition: a complication of blunt trauma or penetrating trauma in which abdominal contents herniate through the diaphragmatic defect into the thorax
  • Clinical features

For more information on diagnosis and management, see “Diaphragmatic rupture” in “Penetrating trauma.”

  1. American College of Surgeons and the Committee on Trauma. ATLS Advanced Trauma Life Support. American College of Surgeons ; 2018
  2. Marx JA, Hockberger RS, Walls RM et al. Rosen's Emergency Medicine - Concepts and Clinical Practice. Saunders ; 2013
  3. Mortality in the United States, 2020. https://www.cdc.gov/nchs/products/databriefs/db427.htm#Summary. Updated: December 21, 2021. Accessed: May 27, 2022.
  4. Moore EE, V. Feliciano D, Mattox KL. Trauma, Eighth Edition. McGraw Hill Professional ; 2017
  5. Blunt Cardiac Injury. https://www.aast.org/resources-detail/blunt-cardiac-injury. Updated: November 1, 2012. Accessed: April 6, 2022.
  6. Kaye P. Myocardial contusion: emergency investigation and diagnosis. Emergency Medicine Journal. 2002; 19 (1): p.8-10. doi: 10.1136/emj.19.1.8 . | Open in Read by QxMD
  7. Yousef R, Carr JA. Blunt Cardiac Trauma: A Review of the Current Knowledge and Management. Ann Thorac Surg. 2014; 98 (3): p.1134-1140. doi: 10.1016/j.athoracsur.2014.04.043 . | Open in Read by QxMD
  8. Joos E, Tadloc MD, Inaba K. Diagnosis, work-up and management of blunt cardiac injuries. Trauma. 2014; 16 (2): p.93-98. doi: 10.1177/1460408614525740 . | Open in Read by QxMD
  9. Stojanovska J, Hurwitz Koweek LM, Chung JH, et al. ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury. Journal of the American College of Radiology. 2020; 17 (11): p.S380-S390. doi: 10.1016/j.jacr.2020.09.012 . | Open in Read by QxMD
  10. Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015; 7 (Suppl 1): p.S44-49. doi: 10.3978/j.issn.2072-1439.2015.01.11 . | Open in Read by QxMD

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