Repeat computed tomography is highly sensitive in determining need for delayed exploration in blunt abdominal trauma

Brooke, Magdalene A.; Victorino, Gregory P.

doi:10.1016/j.jss.2017.05.107

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Changes in the clinical and laboratory picture (abdominal physical examination, increase in white blood cell count, lactate and amylase levels) should raise the suspicion of significant HVMI and suggest further investigations. Repeated imaging such as abdominal US [26] or a second ceCT [27], suggested as mandatory by some Authors after a standardized time from first evaluation [12,28], may help in this set of patients to add valuable additional information, particularly useful in in non-assessable patients (spinal cord injury and/or impaired level of consciousness): if an increase to a significant number of positive criteria is reported, laparotomy should be again a reasonable indication.…”

Section: Discussionmentioning

confidence: 99%

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

et al. 2020

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Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

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Section: Discussionmentioning

confidence: 99%

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

et al. 2020

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“…In the context of high-risk mechanisms (MVA > 64kmph, pedestrian vs car, fall > 20 m, etc. [ 41 ]) without peritoneal signs but subtle signs on initial CT, a follow-up CT can improve sensitivity and specificity in detecting bowel injuries [ 42 , 43 ]. With time enteric fluid pools and intraluminal gas can leak in the peritoneal cavity.…”

Section: Blunt Abdominal Trauma: Role and Pitfalls Of Ct In The Diagn...mentioning

confidence: 99%

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

et al. 2022

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The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.

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“…[10][11][12][13][14] The sensitivity increases to approximately 100% in the repeated CT scans while the specificity also increases to 86%. [15] However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ultrasound and physical examination with the gold standard computerized tomography in patients with blunt abdominal trauma

Hekimoğlu

Ergün

Özkan

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS:In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS:The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION:Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

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Repeat computed tomography is highly sensitive in determining need for delayed exploration in blunt abdominal trauma

Cited by 4 publications

References 14 publications

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Comparison of ultrasound and physical examination with the gold standard computerized tomography in patients with blunt abdominal trauma

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