A Prospective Study of 91 Patients Undergoing Both Computed Tomography and Peritoneal Lavage Following Blunt Abdominal Trauma

Fabian, Timothy C.; Mangiante, Eugene C.; White, Thomas J.; Patterson, C. Richard; Boldreghini, Sandra J.; Britt, L. G.

doi:10.1097/00005373-198607000-00003

Cited by 123 publications

(16 citation statements)

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“…The nontherapeutic (false-positive) laparotomy rate of diagnostic modalities ranges widely: 4-20% for DPL, 3,6,11,16,19,24,30,32,44 0-33% for CT, 14,25,45 and 0-24% for US. 4,26,[46][47][48] The delayed laparotomy (false-negative) rate ranges up to 16% for DPL 23 and is 8-25% for CT. 22,45 The delayed laparotomy rate for US was not reported in the literature we reviewed. Determining an acceptable standard depends in part on the consequences of a missed injury and the morbidity and mortality of a nontherapeutic operation.…”

Section: Discussionmentioning

confidence: 94%

“…Overall complication rates (morbidity and mortality) range from 0% to 7.7% and vary with technique. 1,3,7,[9][10][11][12]16,21,22,27,29,31,32,49,50 Studies 7,9,10,25,47,49,51 report sensitivity, specificity, and accuracy along with positive and negative predictive values; however, they reflect a variation in technique and criteria for a positive result. Accuracy is reported to range from 67% to 99%.…”

Section: Discussionmentioning

confidence: 99%

“…Accuracy is reported to range from 67% to 99%. 5,6,[9][10][11]16,18,21,22,[27][28][29]31,40,52 Sensitivity is reported to range from 73% to 100%. 9,10,13,15,[17][18][19]21,23,24,27,29,31,32,34,35,38,40,50,53 Specificity is reported to range from 58% to 100% and is reflective of the variation in criteria for a positive test.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Evaluation of Patients with Blunt Abdominal Trauma: A Decision Analysis

Brown

Dunn

Wilson

2000

Academic Emergency Medicine

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Abstract. Objectives: Using decision analysis, to compare the expected utility (EU) of diagnostic peritoneal lavage (DPL), computed tomography (CT), and ultrasonography (US) to determine the optimal modality for the evaluation of blunt abdominal trauma (BAT) in hemodynamically stable adults. Methods: Data points for the decision analysis were obtained from three sources: 1) prevalence of BAT and the sensitivity and specificity of each diagnostic modality were determined through a criteria-based review of the literature; 2) rate of BAT necessitating immediate intervention, perioperative complication rate, and operative mortality rate were calculated using data from the authors' institution's trauma registry; and 3) outcome utilities were determined by telephone survey of adults in a random sample of households in the region. The decision tree was constructed and evaluated in standard fashion. For each diagnostic modality, the authors calculated the EU using the minimum, mean, and maximum sensitivity and specificity across a range of prevalence. Mean outcome utilities were used for each branch of the tree when calculating the EU. Results: The EU of CT was consistently lower than the EUs of DPL and US at all levels of prevalence. However, the rank order of the EUs of US and DPL varied with the prevalence of BAT. When the prevalence was <30%, the EU of US was higher than that for DPL. When the prevalence was 30-40%, the EUs were similar. When the prevalence was >40%, the EU of US was less than that of DPL. Conclusions: Among institutions operating under constraints similar to those used in this model, the optimal diagnostic modality for the evaluation of BAT can be determined based on the sensitivity and specificity of the modality at their institution and the prevalence of BAT in their patient population.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Evaluation of Patients with Blunt Abdominal Trauma: A Decision Analysis

Brown

Dunn

Wilson

2000

Academic Emergency Medicine

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“…10,18 The sensitivity of CT scan with OC for the diagnosis of blunt bowel injury ranges from 80% and 100% depending on the criteria used. 14,19,21 Kearney et al 14 reported a sensitivity of only 80% for detection of bowel injury by CT scan with OC, while Sherck et al 19 reported a sensitivity of 92%. In a center where OC is not used in the protocol for blunt abdominal trauma CT scans, 6 patients with small-bowel injury at laparotomy all had findings on CT that were suggestive of bowel injury and 2 of these only had bowel wall thickening and free peritoneal fluid.…”

Section: Commentmentioning

confidence: 99%

Oral Contrast Solution and Computed Tomography for Blunt Abdominal Trauma

Stafford

McGonigal²,

Weigelt³

et al. 1999

Arch Surg

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“…There is a marked learning curve in the interpretation of CT scans of the injured abdomen and experience of some 200 CT scans of the injured abdomen is an estimated minimum acceptable baseline on which to base acute management decisions (Peitzman, 1989 personal communication). Fabian et al (1986) concluded that even with experienced radiologists, CT offered no diagnostic advantage over DPL. CT is slower, more expensive and third generation scanners are essential for adequate scan quality.…”

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confidence: 99%