Diagnostic Accuracy of Computed Tomography for the Prediction of the Need for Laparotomy for Traumatic Hollow Viscus Injury: Systematic Review and Meta-Analysis

Abstract

Background: Traumatic hollow viscus injury (THVI) is one of the most difficult challenges in the trauma setting. Computed tomography (CT) is the most common modality used to diagnose THVI; however, various performance outcomes of CT have been reported. We conducted a systematic review and meta-analysis to analyze how precise and reliable CT is as a tool for the assessment of THVI. Method: A systematic review and meta-analysis were conducted on studies on the use of CT to diagnose THVI. Publications were retrieved by performing structured searches in databases, review articles and major textbooks. For the statistical analysis, summary receiver operating characteristic (SROC) curves were constructed using hierarchical models. Results: Sixteen studies enrolling 12,514 patients were eligible for the final analysis. The summary sensitivity and specificity of CT for the diagnosis of THVI were 0.678 (95% CI: 0.501–0.809) and 0.969 (95% CI: 0.920–0.989), respectively. The summary false positive rate was 0.031 (95% CI 0.011–0.071). Conclusion: In this meta-analysis, we found that CT had indeterminate sensitivity and excellent specificity for the diagnosis of THVI.

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

“…CT is the standard imaging modality for evaluating hemodynamically stable patients with blunt abdominal trauma, stab wounds to the flank and thoracoabdomen, and gunshot wounds [ 10 13 ]. For blunt bowel and mesenteric injuries, CT has high specificity but modest sensitivity for detecting lesions that require therapeutic laparotomy [ 15 16 ]. A recent meta-analysis of 16 studies that enrolled 12514 patients with blunt trauma has reported a pooled sensitivity of 67.8% and specificity of 96.9% for CT [ 15 ].…”

“…For blunt bowel and mesenteric injuries, CT has high specificity but modest sensitivity for detecting lesions that require therapeutic laparotomy [ 15 16 ]. A recent meta-analysis of 16 studies that enrolled 12514 patients with blunt trauma has reported a pooled sensitivity of 67.8% and specificity of 96.9% for CT [ 15 ]. Regarding anterior abdominal stab wounds, a meta-analysis of seven studies (575 patients) has reported a modest pooled sensitivity and specificity of 85% and 81%, respectively, for CT in diagnosing surgical bowel and mesenteric injuries [ 17 ].…”