Defining the role of computed tomography in blunt abdominal trauma: use in the hemodynamically stable patient with a depressed level of consciousness

Abstract

Hypothesis: Controversy exists regarding the use of diagnostic peritoneal lavage (DPL) vs computed tomography (CT) in the evaluation of blunt abdominal trauma. It has been suggested that one role for DPL is to diagnose bowel injuries in hemodynamically stable patients with an unreliable abdominal examination result. Our hypothesis is that CT is specific and sensitive for diagnosing hollow viscus injuries and is therefore an appropriate diagnostic modality in the hemodynamically stable blunt trauma patient with an unreliable abdominal examination result due to a depressed level of consciousness.

Design: Retrospective consecutive case review.

Setting: An urban level II trauma center.

Patients: The medical records of 1388 consecutive patients admitted between January 1, 1991, and December 31, 2000, were reviewed. Inclusion criteria included blunt trauma patients who were hemodynamically stable (defined as a systolic blood pressure >90 mm Hg) with unreliable abdominal examination results secondary to a depressed level of consciousness (Glasgow Coma Scale score <11).

Main outcome measures: Hollow viscus injury diagnosed by CT and missed diagnosis of hollow viscus injury by CT.

Results: Of 1388 patients who met entry criteria, 87 had hollow viscus injuries; CT identified 85 of these injuries. Computed tomography diagnosed intestinal injury with a sensitivity of 97.7%, specificity of 98.5%, and an overall accuracy of 99.4%.

Conclusion: At our institution, CT is a reliable and accurate diagnostic modality when used to evaluate hollow viscus injuries in the hemodynamically stable blunt trauma patient with an unreliable abdominal examination result due to a depressed level of consciousness.