Admission or Observation Is Not Necessary after a Negative Abdominal Computed Tomographic Scan in Patients with Suspected Blunt Abdominal Trauma

Livingston, David H.; Lavery, Robert F.; Passannante, Marian R.; Skurnick, Joan; Fabian, Timothy C.; Fry, Donald E.; Malangoni, Mark A.

doi:10.1097/00005373-199802000-00005

Cited by 212 publications

(109 citation statements)

References 15 publications

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“…Livingston et al [28] demonstrated a negative predictive value of 99 % for WBCT and concluded that there are no advantages for prolonged surveillance or hospital admission after completion of a WBCT examination in patients with blunt abdominal trauma. Moreover, Huber-Wagner et al [7] demonstrated that WBCT is a relevant and safe diagnostic tool even in hemodynamically unstable patients associated with increased survival even in severely injured patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography

Schneck

Koch

Borgards

et al. 2017

Fortschr Röntgenstr

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ABSTR ACTPurpose Patients suffering from severe blunt abdominal trauma are challenging because of their need for accurate diagnostic imaging and fast therapeutic action. Whole-body computed tomography (WBCT) is highly sensitive and represents the gold standard in the trauma room diagnostic setting. The aim of our study was to investigate the impact and therapy relevance of abdominal follow-up sonography (AFS) as part of the tertiary trauma survey (TTS) in patients without abdominal parenchymal organ lesions or free abdominal fluid in initial WBCT. Results 316 patients were analyzed (ISS 10 ± 8, NISS 13 ± 11) according to the inclusion criteria. Overall, only small amounts of free intraabdominal fluid were detected in AFS in 3 patients (0.9 %) and remained without therapeutic consequence. None of the patients died due to intraabdominal bleeding. Materials and MethodsConclusion AFS as part of the TTS did not show additional benefits and had no impact on further treatment in patients without abdominal parenchymal organ lesions or free intraabdominal fluid in the initial WBCT examination.We conclude that AFS is not routinely required but should be performed if indicated on a clinical or laboratory basis because of its fast and less invasive character.Key points ▪ Seriously injured patients are challenging for medical imaging and treatment. ▪ Whole-body computed tomography is known for its high accuracy in trauma patients. ▪ Nonetheless, missed injuries are a major challenge in trauma patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography

Schneck

Koch

Borgards

et al. 2017

Fortschr Röntgenstr

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“…In the haemodynamically stable patient, performing CTAP in such patients may even allow them to be discharged from the emergency department due to its high negative predictive value. 1 In view that CTAP has a much higher sensitivity (92-98%) and specificity (99%) 2 as compared to FAST (sensitivity 73-88%, specificity 98-100%), 3 we wanted to evaluate if ultrasound would still be reliable and u s e f u l i n t h e m a n a g e m e n t o f t h e m u l t i p l y injured patient with blunt abdominal injury in our centre.…”

Section: Discussionmentioning

confidence: 99%

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Wong¹,

Ngo

Wee³

et al. 2014

Hong Kong Journal of Emergency Medicine

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Focused assessment with sonography in trauma (FAST): experience of a tertiary hospital in Southeast Asia創傷超聲重點評估（FAST）：東南亞一間三級醫院的經驗 E Wong 王怡玲, ASY Ngo 吳淑瑩, JCP Wee 黃俊評, JMH Lee 李美華 Objective: This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design: Retrospective cross-sectional study. Setting: A tertiary hospital. Methods: Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results: A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions: In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236) 目的：本研究比較了創傷超聲重點評估（ FAST ）與腹腔 / 盆腔 CT 掃描（ CTAP ），在腹部閉合性損傷的陽性預測值（ P P V ）和陰性預測值（ NP V ），以及是否需要腹部手術。我們還試圖確定假陰性的超聲檢查，是否與有重大的併發症有關。並將結果與其他研究進行比較。設計：回顧性橫斷面研究。

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“…Spleen (111) Kidney (69) Others (6) Liver (6) Spleen (6) Kidney ( Others (22) Bowel and mesentery (6) Diaphragm (2) Gall bladder (1) Urinary bladder (1) Inferior vena cava (1) Liver (4) Kidney (3) Pancreas (1) Atrium (1) Liver ( have suggested that a blunt trauma patient could be discharged safely after a negative CT examination. [3,4] However, another study compared the results of CT and autopsy in 113 trauma patients and found that CT had a high rate of missed diagnoses of abdominal organ injuries. [5] In addition, CT has proven to be less useful in detecting hollow viscus injuries.…”

Section: Discussionmentioning

confidence: 99%

Will computed tomography (CT) miss something? The characteristics and pitfalls of torso CT in evaluating patients with blunt solid organ trauma

Kuo¹,

Lin²,

Foo³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇSelektif non-operatif tedavi, künt solid organ travmalı hastalar ile ilgili standart tedavi haline gelmiştir ve bilgisayarlı vücut tomografisi (BT) yararlı terapötik ipuçları sağlamak-tadır. Biz, bu çalışmayı künt solid organ travmalı hastalarda atlanan tanıların sıklığını ve karakterini belirlemek üze-re yürüttük. BULGULARHastalar, atlanmış bir tanı bulunup bulunmamasına göre atlanan grup (24 hasta) ve değişmeyen grup (262 hasta) şek-linde gruplara ayrıldı. Genel atlanan tanı oranı %8,4 idi. Yalnızca tanımlanmamış bir bağırsak yaralanması takip BT'si ile açığa çıkarıldı, atlanan yaralanmaların hepsi laparotomi ile ortaya çıkarıldı. Atlanan grup, daha yüksek bir Yaralanma Şiddet Skoru, daha düşük Glasgow Koma Skalası, daha fazla Yoğun Bakım Ünitesi (YBÜ) tedavisi ve daha uzun hastanede kalma süresine sahip olmuştur. SONUÇCiddi travması uzun süre devam eden hastalarda, atlanmış tanıların ortaya çıkarılması seyrektir. Laparotomi atlanmış tanı-ların hepsini ortaya çıkarmış ve takip BT'si tanımlanmamış yaralanmaların saptanmasında düşük bir yeteneğe sahip olduğunu ortaya koymuştur. Klinik kötüleşme oluşması durumunda, künt solid organ travmalı hastaların non-operatif tedavisinde takip BT'si yerine laparotomi yapılmasını öneriyoruz.Anahtar Sözcükler: Künt abdominal travma; bilgisayarlı tomografi; laparotomi; atlanan yaralanma; solid organ yaralanması.

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Admission or Observation Is Not Necessary after a Negative Abdominal Computed Tomographic Scan in Patients with Suspected Blunt Abdominal Trauma

Abstract: These data indicate that abdominal tenderness is not predictive of an abdominal injury and that patients with a negative CT scan after suspected blunt abdominal trauma do not benefit from hospital admission and prolonged observation.

Cited by 212 publications

References 15 publications

Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography

Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography

Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia

Will computed tomography (CT) miss something? The characteristics and pitfalls of torso CT in evaluating patients with blunt solid organ trauma

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