| ObjectiveThe author statistic Blunt Abdominal Trauma (BAT) during 1990 to 2004 year, 1257 medical records of BAT to construct the Specialized Microsoft Excel date-base of BAT (SMEDBAT), in nanfang hospital and experiences concerned were summarized.l.Use the date-base to analyse the character of epidemiology of BAT in the area of guangzhou.2.To statistic the diagnostic method of BAT and analyse the influence of assistant examination in BAT.3.To explore the factor of misdiagnosis in BAT.4. To explore the influence factors of prognosis , analyse this date-base ,get the best examination ,diagnosis and treatment method ,enhance the level of diagnosis and treatment of BAT.MethodAnalyse BAT records , a total of 1257 medical records of BAT during 1990 to 2004 year in nanfang hospital were used to create a SMEDBAT with a personal computer and correlated software, the standard of the constitution of SMEDBAT is the BAT patients that enrolled in all of the departments of nanfang hospital. There are 27 item in the BAT date-base. Use the date-base. to analyse the character of epidemiology of BAT in the area of guangzhou. to analyse the factors of influence in diagnosis of BAT analysis in multiple regression, to analyse the misdiagnosis inBAT, and to analyse the factors of influence in prognosis of BAT.Numeration data analyse in Chi Square Test ; and analyse the influence of assistant examination in multiple regression . in all analysis, p-vahie lower than 0.01 were accepted as statistical difference. Result1. The SMEDBAT consisting of 1257 medical records on BAT in hospital was established within one year, and the statistical analysis of date in it had been finished .The data-base system , which possesses powerful capacity for the management information of BAT, works in good condition.2 . Epidemiology of BAT .2.1 > The reason of trauma : the reason of trauma from mostly to subordination: traffic accident( 51.5%)> boxing attack (18.9%), falling(14.9%), bumping (10.6%) , medical injured (1.52%), tamping (1.21%)> machinery injured (0.91%) etal.2.2> Injured of viscera from the most to subordination.- spleen(21.5%) > liver(20.0%), kidney (15.1%), small intestine (11.6%), pancreas(5.4%), large intestine(5.2%)> stomach(4.9%)> duodenum(0.9%)et. al.3. Factors of influence in diagnosis of blunt abdominal trauma analysis in multiple regression .in this text ,depart the diagnostic method of BAT and statistic the influence of assistant examination to five points .3.1 Physical examination and diagnostic peritoneal tap(DPT): In the SMEDBAT ,1219 of them were used DPT (1219/1257 97.0%), physical examination and DPT confirmed 135 (135/972 13.9%) of them operated and6( 6/285 2.1 % ) of them non-operated .the availability of physical examination and DPT is 11.6%o (141/1219).3.2 Ultrasound (US) : In the SMEDBAT ,1043 of them were used US examination ,(1043/1257 83.0%), US confirmed 597 (597/972 61.4%) of them operated and 175 (175/285 61.4%) of them non-operated .the availability of US examination is 74.0% 0 (772/1043).3.3 Computed tomography (CT): In the SMEDBAT ,186 of them were used CT examination ,(186/1257 14.8%), CT confirmed 83 (83/972 8.5%) of them operated and 74 (74/285 26.0%)of them non-operated .the availability of CT examination is 84.4% ? (157/186).3.4 Conventional radiology.- In the SMEDBAT ,433 of them were used Conventional radiology examination (433/1257 34.4%), conventional radiology confirmed 134 (134/972 13.8%)of the operated patient and 25 (25/285 8.7%)of the non-operated patient ,the availability of conventional radiology examination is 36.7% o (159/433).conventional radiology is very important for BAT, especially for the trauma of hollow organ, free intraperitoneal air is the most simple diagnosis method .But ,false positive in conventional radiology can easely cause t misdiagnosis ,we should pay an attention to this phenomena.3.5 Diagnostic laparoscopy and DSA examination : In the SMEDBAT ,twenty eight of them were used diagnostic laparoscopy and DSA examination (28/1257 2.2%), diagnostic laparoscopy and DSA examination confirmed 23 (23/972 2.4%)of them operated and 5 (5/285 1.8%)of them non-operated .the availability of diagnostic laparoscopy and DSA examination is 100% ? (28/28).Statistic the factors of influence in diagnosis of blunt abdominal trauma analysis in multiple regression, and get a regression equation:Y = 0.853 ( a) + 0.642(bi)Xi + 0.246(b2)X2 + 0.125(b3)X3 + 0.062(b4)X4 + 0.013(b5)X5, in this equation, Xi> X2^ X3^ X4. X5 are factors of regression ,(1) ultrasound (US), (2) computed tomography (CT) , (3) conventional radiology , (4) physical examination DPT. (5) Diagnostic laparoscopy. From bi to bs are coefficients of regression4. Seventy two people were misdiagnosis in the SMEDBAT , all of them were attested by Laparotomy , multiple viscera trauma (16.7%, 12/72) .single viscera trauma (80.5%,58/72),negative viscera trauma(2.7%,2/72) ,in all of them 59 of the BAT were diagnosed that had not viscera trauma, eleven of them were diagnosedlow-grade trauma and had not operated in time , two of them were nonoperative operation . eight of them have intercurrent symptom after operation (8/72 11.1%) Among 72 cases of BAT false negative occurred in shifting dullness ( 8/72 11.1%) ,DPT (12/57 21.1%) .ultrasonic (6/47 12.7%), X-ray (16/43 30.2%), CT(2/8 25.0%) and false positive of DPT (2/57 3.5%) are caused misdiagnosis and missed diagnosis.5 . The multiple factors of influence in prognosis ,In the SMEDBAT , nine hundred and seventy two patient (77.3%) of the total be operated at last , thirty six of them have intercurrent symptom after operation (36/972 3.7%) , accordingly 917 of them were operated in 12 hour and 23 of them have intercurrent symptom after operation (23/917 2.5%) ,fifty five of them operated after this time, 13 of them have intercurrent symptom (13/55 23.6%) ,they have obvious different (p <0.01). Conclusion:l.The constitution of date-base for BAT ,which are very useful for doctors to get the better method of examination *. diagnosis and therapy for BAT.2. Received of epidemiology of BAT in the area of guangzhou.2.1 > The reason of trauma : the reason of trauma from mostly to subordination: traffic accident> boxing attacks falling, bumping -. medical injured ,et al.2.2n The injured of viscera from mostly to subordination: spleen, liver > kidney ^ small intestine > pancreas n large intestine.. stomaclK duodenum et. al.3. Statistic the factors of influence in diagnosis of blunt abdominal trauma analysis in multiple regression, and Get a regression equation. In this equation bi > b2 > D3 > b4 > bs means US is the most important influence in diagnostic method in BAT , CT examination> conventional radiology^ physical examination DPT or DAP> Diagnostic laparoscopy and DSA are subordinate orderly.4. Most of misdiagnosis in BAT occurred in single viscera trauma , The factor is doctor's omit, impertinent assistant examine and false negative, false positive . 5 Statistic the factors of influence in prognosis of BAT.(1) There are some point factors that can influence intercurrent symptom: degree of trauma -. viscera of injured> time of diagnosis > time of operation and other factors.(2) In the SMEDBAT, 972 of them were confirmed by Laparotomy , the ratio of intercurrent symptom after operation of them have obvious statistical different (p <0.01).for this cases, in urgent conditions , Laparotomy should be performed actively in BAT ,for prolonged contamination due to gastrointestinal injured is more harmful than negative exploration.
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