Selective Use of Computed Tomography and Diagnostic Peritoneal Lavage in Blunt Abdominal Trauma

Abstract

The purpose of this study was to attempt to identify those blunt trauma patients in whom expensive diagnostic studies such as computed tomography and diagnostic peritoneal lavage are unnecessary to exclude intra-abdominal injury. The medical records of 1096 blunt trauma patients evaluated at an urban level I trauma center were reviewed. Because of the urgent need to exclude intra-abdominal hemorrhage in patients with hypotension (blood pressure < 90 mm Hg), and the difficulty in obtaining reliable information from abdominal examination in patients with Glasgow Coma Scale scores< 11 or spinal cord injury, 140 patients meeting these criteria were reviewed but excluded from statistical analysis. Six groups of major associated injuries felt to be potential risk factors for the prediction of intra-abdominal injury were analyzed in the 956 remaining patients. Only two of these potential risk factors, namely chest injury (p = 0.0001) and gross hematuria (p = 0.0003) attained statistical significance. All of the 44 significant intra-abdominal injuries occurred in the group of 253 patients that had either an abnormal abdominal examination, one of the statistically significant risk factors, or both, for a sensitivity of 100%. Of the 703 patients with a normal abdominal examination and no risk factors, none had a significant abdominal injury, for a negative predictive value of 100%. This study suggests that patients with either an abnormal abdominal examination or one of the two statistically derived risk factors require adjunctive diagnostic evaluation with diagnostic peritoneal lavage or computed tomography scan to exclude intra-abdominal injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Pelvic bone fractures associated with intra-abdominal solid organ injury

“…[11,[21][22][23][24] Selective utilization of CT scanning has been advocated for due to radiation exposure and cost. [22][23][24] However, it has been reported that the treatment plan was changed in 6.4% of cases due to diagnoses determined from CT imaging.…”

“…[11,[21][22][23][24] Selective utilization of CT scanning has been advocated for due to radiation exposure and cost. [22][23][24] However, it has been reported that the treatment plan was changed in 6.4% of cases due to diagnoses determined from CT imaging. [11] It is difficult to conclusively state whether CT scans should be performed selectively or routinely so to better diagnose abdominal solid viscera injury in patients with pelvic bone fractures because of the limitations of our study.…”

Challenges of surgical trauma emergency admission

“…Abdominal injuries are characterized by a discrepancy between clinical examination and actual abdominal injuries. In only 26% of all patients with clinical findings suggesting an abdominal injury, the CT showed an abdominal injury [48]. In contrast, pelvic fractures were shown as a risk factor for abdominal injuries [49,50].…”

Hyalen Membran Hastalığı Tanısının Adli Otopsilerdeki Önemi Olgu Sunumu

“…Peritoneal lavaj 2 yaşın altında 250 mİ, 2-5 yaş arasında 500 mİ, 6 yaş ve yu karısında 1000 ml Ringer Laktat infüze edilerek ger çekleştirilir. Peritoneal lavajın pozitiflik kriterleri şun lardır (15,17,19,20):…”