Critical Issues in the Evaluation of Adult Patients Presenting to the Emergency Department With Acute Blunt Trauma

Based on 2024 guideline for acute blunt trauma from the American College of Emergency Physicians.

Strength

Evaluation

Imaging

Level C

Due to the lack of quality evidence, use clinical judgment and hospital-specific protocols to decide between selective CT and whole-body CT imaging in hemodynamically stable, adult, patients with blunt trauma. [Consensus]

Geriatric

Level B

Emergency physicians should factor age (greater than 65 years) into triage of older adult patients with trauma as they have increased morbidity and mortality compared with similarly injured adults.

Treatment

Blood Products

Level B

In adult patients presenting to the ED with blunt trauma, use a fresh frozen plasma (FFP): platelet: packed red blood cells (PRBC) ratio from 1:1:1 to 1:1:1.5 to reduce 24-hour mortality without increasing morbidity.

Intervention

Level B

In arrested or periarrest adult, patients with blunt trauma, do not routinely use resuscitative endovascular balloon occlusion of the aorta (REBOA) over ED thoracotomy.

Literature

Original/Primary Reference

Clinical Policy: Critical Issues in the Evaluation of Adult Patients Presenting to the Emergency Department With Acute Blunt Trauma Gerardo, Charles J. et al. Annals of Emergency Medicine, Volume 84, Issue 4, e25 - e55

Summary By

Eric Steinberg, DO, MEHP

What do the ratings mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on Class III studies, or in the absence of any adequate published literature, based on panel consensus.