Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs?

Abstract

Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019. Those patients between the ages of 18 and 65 who were referred to the trauma team with a CT scan of the abdomen and had low-risk mechanisms of injury, a Glasgow Coma Scale (GCS) score of 15, and normal vital signs at presentation were included. Patients in the lowest trauma categorization (Level Three, Consult) met the study definition for the low-risk mechanism of injury. Demographic and clinical data were abstracted for all patients. For this analysis, patients were divided into two groups based on age (18-40 years or 40-65 years). Injuries found on CT, their clinical significance, and the likelihood of being missed without CT were determined. Results Of 2,103 blunt trauma patients that received a CT scan of the abdomen from January 2015 to October 2019, 134/2,103 (6.4%) met the inclusion criteria (mean age: 44.6 years; 72.3% male). Patients between the ages of 40 and 65 years comprised 61.2% (82/134) of the study population. Of the included patients, 17.2% (23/134) had at least one acute traumatic injury identified after CT imaging of the torso. Occult injuries found on CT included rib fracture with associated lung injuries (10/23, 43.5%), splenic laceration (4/23, 17.4%), liver laceration (3/23, 13.0%), gluteal hematoma with active bleeding (1/23, 4.3%), sternal fractures (3/23, 13.0%), and thoracic or lumbar spine fractures (2/23, 8.7%). An independent review of the medical records determined that 9.0% (12/134) of these patients had traumatic injuries that would have been missed based on clinical examination without CT. Conclusions Based on our experience, utilizing CT imaging of at least the abdomen as a routine screening measure for all trauma consults-even low-risk patients with normal vital signs-can rapidly and accurately identify clinically significant injuries that would have been otherwise missed in a notable portion of the population.

Missed abdominal injury: why and how to deal? A retrospective interventional study

“…It will delay the dealing with the missed injury and likely to prolong the hospitalization and increase morbidity and mortality. 5,6 Like our study, other study found longer hospitalization period in missed injury group, 7 if we do not include the initial hospitalization period, it was not found significant in this study, as we took decision within 24-28 hrs. Hospitalization cost is also an important factor in therapy, but the whole period was treated free in military hospital, hence it was not taken into consideration.…”

“…4 In such scenario, high resolution CT screening is recommended. 5 In abdominal trauma, the findings of CT are based on the amount of bleeding. More is the intra-abdominal bleeding more is the CT scan findings.…”

A rare case of delayed splenic rupture following initial negative CT scan imaging: A case report and review of the literature

“…Intravenous contrast-enhanced CT scans are now the standard for diagnosing splenic injuries, with The EAST Practice and Management Guideline noting that CT scans are the most accurate, specific, and sensitive in identifying and characterizing splenic injury [15] , [16] . CT scans often diagnose occult injuries and injuries that would have been missed if based on clinical examination solely; yet, the literature also suggests that the rate of missed splenic vascular injuries remains largely unknown [14] , [17] , [18] . Moreover, it is possible that index imaging may be inadequate and fail to capture vascular damage or parenchymal disruption, especially due to contrast timing or patient motion [13] .…”

“…For treatment in our patient, a splenectomy was ultimately completed to handle the DSR. Management of splenic injuries with NOM has become increasingly popular, even in more severely injured spleens [18] . NOM has had escalating success over the years, especially with the incorporation of splenic angioembolization as an adjunct [19] , [21] .…”

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

“…Pediatric patients, particularly infants and young children, are more sensitive to radiation exposure compared to adults. Their increased radiosensitivity stems from their developing bodies, higher metabolic rates, and longer life expectancies, which provide more time for potential radiation-related effects to manifest [ 6 , 25 , 50 ]. Therefore, guidelines for pediatric CT imaging generally aim to minimize unnecessary radiation exposure [ 51 ].…”