Clinical utility of the clinical abdominal scoring system in predicting the need for laparotomy following blunt abdominal trauma

Background: Blunt abdominal trauma (BAT) remains a major cause of morbidity and mortality in emergency surgical practice. Early identification of patients requiring laparotomy is essential to reduce complications and improve outcomes. The objective of this study was to evaluate the Clinical Abdominal Scoring System (CASS) in predicting the necessity of laparotomy and clinical outcomes in patients with blunt abdominal trauma. Methods: This prospective observational study was conducted in the Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak, from May 2024 to May 2025. A total of 70 patients with blunt abdominal trauma were included. Clinical parameters including pulse rate, systolic blood pressure, Glasgow Coma Scale, abdominal findings, and time of presentation were used to calculate the CASS score. Radiological investigations including eFAST, X-ray abdomen, and contrast-enhanced CT were performed. Patients were managed conservatively or surgically based on clinical findings and scoring. Results: The mean age of patients was 27.60±13.69 years, with male predominance (82.85%). Road traffic accidents were the most common mechanism of injury (81.42%). Conservative management was successful in 78.57% of patients, whereas 21.42% required surgery. Patients requiring surgical intervention had significantly higher mean CASS scores compared to conservatively managed patients (12.40±0.63 vs. 7.84±1.34, p<0.001). Mortality was significantly associated with higher CASS scores (12.50±0.71 vs. 8.71±2.19, p=0.017). Conclusion: CASS is a simple, rapid, cost-effective, and reliable bedside scoring system that correlates significantly with operative requirement and clinical outcomes in blunt abdominal trauma patients.