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Observational Study
. 2015 May;209(5):834-40.
doi: 10.1016/j.amjsurg.2015.01.005. Epub 2015 Feb 21.

An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive Focused Assessment with Sonography in Trauma examination

Mackenzie R Cook  1 , John B Holcomb  2 , Mohammad H Rahbar  3 , Erin E Fox  2 , Louis H Alarcon  4 , Eileen M Bulger  5 , Karen J Brasel  6 , Martin A Schreiber  6 ; PROMMTT Study Group
Collaborators, Affiliations
Observational Study

An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive Focused Assessment with Sonography in Trauma examination

Mackenzie R Cook et al. Am J Surg. 2015 May.

Abstract

Background: Positive Focused Assessment with Sonography in Trauma examination and hypotension often indicate urgent surgery. An abdomen/pelvis computed tomography (apCT) may allow less invasive management but the delay may be associated with adverse outcomes.

Methods: Patients in the Prospective Observational Multicenter Major Trauma Transfusion study with hypotension and a positive Focused Assessment with Sonography in Trauma (HF+) examination who underwent a CT (apCT+) were compared with those who did not.

Results: Of the 92 HF+ identified, 32 (35%) underwent apCT during initial evaluation and apCT was associated with decreased odds of an emergency operation (odds ratio .11, 95% confidence interval .001 to .116) and increased odds of angiographic intervention (odds ratio 14.3, 95% confidence interval 1.5 to 135). There was no significant difference in 30-day mortality or need for dialysis.

Conclusions: An apCT in HF+ patients is associated with reduced odds of emergency surgery, but not mortality. Select HF+ patients can safely undergo apCT to obtain clinically useful information.

Keywords: Computed tomography scan; FAST examination; Trauma.

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Figures

Figure 1
Figure 1
Figure 1A: Multivariable model predicting odds of proceeding to an urgent operation in initially hypotensive patients with a positive FAST. CT: abdominal pelvis CT scan, ISS: Injury Severity Score, aSBP: admission systolic blood pressure. R2 = 0. Figure 1B: Multivariable model predicting odds of proceeding to an urgent angiographic intervention in initially hypotensive patients with a positive FAST. GCS: Glasgow Coma Score, aHR: admission hear rate, aSBP: admission systolic blood pressure, Blunt: blunt mechanism of injury, ISS: Injury Severity Score, CT: abdomen pelvis CT scan. R2 = 0.304.
Figure 1
Figure 1
Figure 1A: Multivariable model predicting odds of proceeding to an urgent operation in initially hypotensive patients with a positive FAST. CT: abdominal pelvis CT scan, ISS: Injury Severity Score, aSBP: admission systolic blood pressure. R2 = 0. Figure 1B: Multivariable model predicting odds of proceeding to an urgent angiographic intervention in initially hypotensive patients with a positive FAST. GCS: Glasgow Coma Score, aHR: admission hear rate, aSBP: admission systolic blood pressure, Blunt: blunt mechanism of injury, ISS: Injury Severity Score, CT: abdomen pelvis CT scan. R2 = 0.304.
Figure 2
Figure 2
Multivariable model predicting propensity for initially hypotensive patients with a positive FAST exam to undergo a CT scan during initial trauma evaluation. GCS: Glasgow Coma Score, aHR: admission hear rate, aDBP: admission diastolic blood pressure, aSBP: admission systolic blood pressure, Blunt: blunt mechanism of injury. R2 = 0.185.
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