SynthesisWorld journal of emergency surgery : WJES2026
Incidence of intra-abdominal injury after blunt abdominal trauma with negative CT scan: a systematic review and meta-analysis.
Synthesis in World journal of emergency surgery : WJES, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMissed intra-abdominal injuries (IAI) after blunt abdominal trauma (BAT) with a negative CT scan are rare, but incidence estimates vary across populations and over time, leading to heterogeneous practices regarding observation and discharge. The aim of this study is to synthesize available evidence to estimate the incidence of IAI among patients with BAT and a negative CT scan and to examine how different characteristics influence this risk.
methodsSystematic searches were conducted in MEDLINE, EMBASE, CENTRAL, and LILACS from inception to May 12, 2025, without language restrictions, and supplemented with WoS, trial registries and grey literature sources. Eligible studies included cohort, cross-sectional, case-control studies, or randomized trials evaluating patients of any age with BAT who underwent CT with negative findings for IAI. Emergent procedures and hemodynamic instability were exclusion criteria. Screening and study selection were performed independently by two reviewers. Duplicate and independent data extraction was conducted. Reporting followed PRISMA guidelines and quality was assessed using the Joanna Briggs Institute tool. Pooled incidences were estimated using random-effects meta-analysis. The primary outcome was the incidence of IAI in patients with negative CT scans, and subgroup and sensitivity analyses were performed to assess heterogeneity and robustness.
resultsThirty-one studies comprising 27,342 patients were included. The pooled incidence of IAI after a negative CT was 0.34% (95% CI, 0.21-0.51%). Heterogeneity was substantial (I
conclusionsIn patients with blunt abdominal trauma and a negative CT scan, the incidence of intra-abdominal injury is exceedingly low (0.34%). These findings provide robust, contemporary evidence to inform clinical decisions regarding the need for in-hospital observation and support consideration of early discharge in most patients, while recognizing that individuals with high-risk clinical features may warrant closer monitoring.
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