Predictors of Need for Laparotomy in Blunt Abdominal Trauma Presenting to a Tertiary Care Hospital in Swat
Abstract
Background & Objective: Blunt abdominal trauma remains a frequent and often unpredictable emergency presentation, and deciding which patients need laparotomy versus conservative management can be difficult in the first few hours after injury. Delays in this decision are known to worsen outcomes, particularly in settings with limited resources. We set out to determine which clinical and point-of-care findings could help predict the need for laparotomy in patients presenting with blunt abdominal trauma to a tertiary care hospital in Swat. Methodology: A cross-sectional study was conducted in the Department of Emergency, Saidu Group of Teaching Hospitals, Swat, over three months (February–May 2026). 164 patients with blunt abdominal trauma were enrolled by consecutive sampling. Demographic, clinical, and laboratory variables, including peritonism, FAST scan result, systolic blood pressure, Glasgow Coma Scale, hemoglobin, and associated injury, were recorded. Predictors of laparotomy were identified using multivariable binary logistic regression; model discrimination was assessed with ROC/AUC analysis. Results: Laparotomy was performed in 47/164 patients (28.7%). On multivariable analysis, peritonism (OR 6.47, 95% CI 2.44–17.15, p<0.001), a positive FAST scan (OR 7.77, 95% CI 3.15–19.16, p<0.001), hypotension (SBP<90 mmHg; OR 3.71, 95% CI 1.34–10.29, p=0.012), and lower hemoglobin (OR 0.69 per g/dL, 95% CI 0.54–0.87, p=0.002) were independent predictors of laparotomy. GCS and associated injury were not significant. The model showed good discrimination (AUC 0.86), with sensitivity 80.9% and specificity 81.2% at the optimal cutoff. Conclusion: Peritonism, a positive FAST scan, hypotension, and low hemoglobin independently predicted the need for laparotomy in blunt abdominal trauma. These bedside and point-of-care findings may help emergency clinicians triage patients for early surgical intervention in resource-limited settings. Key Words: Laparotomy, Blunt Abdominal Trauma.