The Role of CT Scan in Evaluation for Laparotomy in Patients with Stab Wounds of the Abdomen

Rehm, Christina G.; Sherman, Roger T.; Hinz, Thomas W.

doi:10.1097/00005373-198904000-00005

Cited by 47 publications

(41 citation statements)

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“…Injuries most difficult to identify with a CT scan are diaphragmatic, gastric, and small-bowel injuries. [12][13][14] Reports of sensitivity between 80% and 94%, specificity between 93% and 94%, accuracy of 90% to 95%, and negative predictive values of 95% to 98% are in line with our observations of 100%, 94%, 97%, and 100%, respectively. 7,11,15 We observed a positive predictive value of 90%, which is higher than the previously reported 80% to 83%.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of Selective Treatment of Penetrating Abdominal Trauma

Schmelzer

Mostafa

Gunter

et al. 2008

Journal of Surgical Education

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Section: Discussionsupporting

confidence: 91%

Evaluation of Selective Treatment of Penetrating Abdominal Trauma

Schmelzer

Mostafa

Gunter

et al. 2008

Journal of Surgical Education

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“…4,5 The experience with AASWs is much more limited. In a study of 50 patients with stab wounds to the back, flank, and lower anterior chest, Rehm et al 29 found that CT with oral and intravenous contrast was useful in identifying peritoneal penetration, solid organ injury, and retroperitoneal injury but was unreliable with respect to hollow viscous injury. They concluded that CT was a valuable adjunct in the preoperative assessment, which may help to reduce the rate of unnecessary laparotomy.…”

Section: Commentmentioning

confidence: 99%

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Salim¹

2006

Arch Surg

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Setting: Academic level I trauma center.Patients and Methods: All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.Main Outcome Measures: Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).Results: One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%. Conclusions:In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.

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“…Darüber hinaus bleiben Hohlorganperforationen und Zwerchfellverletzungen häufig unerkannt [8]. Die Laparoskopie erlaubt eine wesentlich differenziertere Beurteilung der Bauchhöhle.…”

Section: Sonographie/laparoskopieunclassified

“…In Ergänzung zur klinischen Untersuchung und zur Sonographie hat sich als nichtinvasive zuverlässige Maßnahme das Dreifachkontrast-CT mit oraler, rektaler und intravenöser Kontrastierung etabliert [1,5,8,12]. Allerdings bleibt auch bei dieser Untersuchung anzumerken, dass offensichtlich Hohlorganverletzungen nicht erkannt werden [1].…”

Section: Ct-untersuchungunclassified