Those that (still) recommend the pan-scan in trauma, it would seem. Over a once year period, this 803 patient prospective study (451 of which with distracting injuries) evaluated all awake, alert, blunt trauma patients with a GCS of 14-15 to determine the validity of an abdominal exam. Endpoints were injuries which required the OR and those which required a transfusion.
A ten percent failure rate of the abdominal exam for an intra-abdominal injury seems rather high, but this is ten percent of all who actually had an injury. When you consider “all-comers,” it’s more like 1.1% of those with a distracting injury and 0.57% for those without a distracting injury. With that, you would need to scan over a hundred patients to find one intra-abdominal injury that you would have otherwise missed. Throw in the fact that all five missed injuries in the distracted cohort had solid organ injuries, and that none of them required surgical intervention or blood transfusion, and you can see how the authors come to their conclusion:
“These data suggest that clinical examination of the abdomen is valid in awake and alert blunt trauma patients, regardless of the presence of other injuries.”