Definitions for the strength of evidence (Class I-III) and strength of recommendations (A-C) are repeated at the end of the Major Recommendations.
What is the diagnostic performance of computed tomography (CT) in diagnosing significant intra-abdominal injuries requiring intervention in blunt abdominal trauma?
Does oral contrast improve the diagnostic performance of CT in blunt abdominal trauma?
- Level A recommendations. None specified.
- Level B recommendations. Oral contrast is not essential to the evaluation of blunt abdominal trauma.
- Level C recommendations. None specified.
What is the diagnostic performance of focused abdominal sonography for trauma (FAST) in diagnosing hemoperitoneum in blunt abdominal trauma?
- Level A recommendations. None specified.
- Level B recommendations. FAST is useful as an initial screening examination to detect hemoperitoneum in blunt abdominal trauma patients.
- Level C recommendations. None specified.
What is the diagnostic performance of diagnostic peritoneal lavage in diagnosing significant intra-abdominal injuries requiring intervention in blunt abdominal trauma?
- Level A recommendations. None specified.
- Level B recommendations. Diagnostic peritoneal lavage can be used to exclude hemoperitoneum in blunt abdominal trauma patients. Diagnostic peritoneal lavage does not define the extent of injury, has a 1 to 2% complication rate, and may lead to nontherapeutic laparotomies.
- Level C recommendations. On the basis of consensus and current practice patterns, the initial choices for the evaluation of blunt abdominal trauma are CT and FAST, depending on the patient's hemodynamic stability.
Definitions:
Literature Classification Schema^
Class 1
- Therapy*: Randomized, controlled trial or meta-analyses of randomized trials
- Diagnosis**: Prospective cohort using a criterion standard
- Prognosis***: Population prospective cohort
Class 2
- Therapy*: Nonrandomized trial
- Diagnosis**: Retrospective observational
- Prognosis***: Retrospective cohort; case control
Class 3
- Therapy*: Case series; case report; other (e.g., consensus, review)
- Diagnosis**: Case series; case report; other (e.g., consensus, review)
- Prognosis***: Case series, case report; other (e.g., consensus, review)
^ Some designs (e.g., surveys) will not fit this schema and should be assessed individually.
* Objective is to measure therapeutic efficacy comparing >2 interventions
** Objective is to determine the sensitivity and specificity of diagnostic tests
*** Objective is to predict outcome including mortality and morbidity
Strength of Recommendations
Level A recommendations. Generally accepted principles for patient management that reflect a high degree of clinical certainty (i.e., based on "strength of evidence class I" or overwhelming evidence from "strength of evidence class II" studies that directly address all the issues)
Level B recommendations. Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (i.e., based on "strength of evidence class II" studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of "strength of evidence class III" studies)
Level C recommendations. Other strategies for patient management based on preliminary, inconclusive, or conflicting evidence or, in the absence of any published literature, based on panel consensus.
There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude and consequences, strength of prior beliefs, and publication bias, among others, might lead to such a downgrading of recommendations.