The role of computed tomography in blunt abdominal trauma as investigative tool conducted at tertiary level hospital, Vadodara

Abstract

Background: Evaluating patients who have sustained blunt abdominal trauma (BAT) remains one of the most challenging and resourceintensive aspects of acute trauma care. Missed intra-abdominal injuries continue to cause preventable deaths. Aims & Objective: To assess efficacy of CT scan (computed tomography) as accurate diagnostic tool for blunt abdominal trauma patients. Materials and Methods: 87 cases of blunt abdominal injury admitted in S.S.G hospital, Baroda during the period of August 2010 to November 2012 were included in the study after taking written informed consent. All these patients were thoroughly investigated. CT Scan was done for all hemodynamically stable patients. Recorded data included age, sex, type of injuries and scan results. Organ injuries were graded using the OIS (Organ Injury Scale) guidelines. Results: The study comprised of 87 patients having blunt abdominal injury. Majority of the patients were in the age group of 20-29 years. Most common organ injury were splenic (43%), liver (32%) and renal (11%). 95% (83 patients) were positive for abdominal injury and 5% (4 patients) were negative. The CT findings of hemoperitoneum and/or solid organ injury were confirmed in the 15 cases taken up for surgery. Conclusion: In this study CT scan was 100 % sensitive in diagnosis of blunt abdominal trauma. Negative CT scan discourage unnecessary urgent abdominal exploration.

The Role of Computed Tomography in Blunt Abdominal Trauma

“…No age group is exempted from traumatic injury of abdomen, but that it is more common in the second to fourth decade of life because this age represent working population. A similar incidence was reported by Vadodariya et al 3 and Mohapatra et al 9 Majority of our patients were male (Male: female= 2.3:1). The incidence of abdominal trauma in male population is higher because in our country males lead more active life and have more outdoor activities.…”

“…Spleen was the most common organ to be injured followed up by liver, kidney, mesentry, bowel etc. Studies in India by Vadodariya et al, 3 in Jordan by Hamidi et al 2 also showed spleen as the commonest organ to be injured in blunt injury abdomen. Chest injuries, fracture of pelvis and spine were the maximum associated injuries.…”

“…2 Blunt Abdominal Trauma usually results following road traffic accidents, assaults, recreational accidents, or falls. 3 Clinical findings are compounded by factors like fractures of ribs, vertebrae and pelvis or other associated injuries. 4 Major change in the paradigm of the management of blunt abdominal trauma is the introduction of nonoperative management coinciding with the availability of Computed Tomograpy (CT) scans, hence the role of imaging becomes even more paramount for the safe practice of such surgical restraint.…”

“…5,6 CT scans, unlike direct peritoneal lavage (DPL) or Focused Assessment with Sonography for Trauma (FAST), have the capability to determine the source of haemorrhage, defining the severity of solid organ injury, retroperitoneal injuries and genitourinary system. 3,7 It is contraindicated in patients with clear indication of laparotomy and in haemodynamically unstable patients. 8 The objective of the study was to assess the efficacy of CT scan as an accurate diagnostic tool in patients with blunt abdominal trauma and to suggest guidelines based on the above result…”

Computed tomography evaluation of blunt abdominal injury

“…The accuracy of CT in haemodynamically stable BAT has been well established. Sensitivity between 92% and 97.6% and specificity as high as 98.7% have been reported in patients subjected to emergency [5] .…”