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EMERGENCY SITUATION
At practice, a football player attempts to recover a fumble and dives on a loose ball. Two other players fall on top of him as he lands on the ball. He has the wind knocked out of him and he must be helped off the field. He complains of mild abdominal pain, which is localized to the periumbilical area. His blood pressure is 138/72, and his pulse is 96. His abdominal examination demonstrates localized abdominal discomfort on palpation with no rebound tenderness. He has discomfort when contracting his abdominal muscles. He is given an ice bag for the abdomen, and his examination is repeated 15 minutes later. At that time, his blood pressure is 110/68, his pulse is 64, and he has only minimal abdominal tenderness. He expresses a desire to return to practice. As the athletic trainer, what actions should you take?
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Sports-related abdominal emergencies are uncommon. In a 30-year period, Bergovist et al.1 were able to document only 136 abdominal injuries requiring hospitalization in a Swedish county. The dominant age group was 10 to 20 years old, and soccer was the most commonly involved sport, accounting for almost half the injuries. The most common diagnosis was an abdominal wall contusion, accounting for 60 of the 136 injuries studied. The kidney was the most commonly injured organ and was four times more frequently injured than the spleen, the next most commonly injured organ. The authors noted that the abdominal symptoms on admission to the hospital were usually not dramatic, with only eight patients demonstrating signs of clinical peritonitis. Four of the patients were diagnosed with delayed splenic rupture.
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In a search of the National Pediatric Trauma Registry, Wan et al.2 found that sports were responsible for only 6.64% of the cases reported to the trauma centers in the study and comprised only 0.56% of the injuries. Of the injuries, 84% occurred in children between the ages of 12 and 18 years. American football was the most frequently involved sport, with baseball and basketball the next most common. The spleen was the most frequently injured organ across all age groups, with 96 cases, and the kidney was second with 42 cases. Ryan3 noted that the relative infrequency of abdominal injuries put them at risk to go undiagnosed because they are ...