The use of computed tomography in blunt abdominal injuries

Abstract

A retrospective study was performed to evaluate the use of abdominopelvic computed tomography of the abdomen (CTA) in the initial evaluation of hemodynamically stable blunt trauma patients. Two hundred fifty-six of 2,047 injury admissions over a 2-year period underwent CTA. Sixty-two (24.2%) scans were positive for visceral injury. Sensitivity of CTA for patients with visceral injury was 92.4 per cent, specificity was 99.5 per cent, and overall accuracy was 97.6 per cent. Of all injuries documented by CTA or laparotomy, CTA detected 83.7 per cent. Injury-specific sensitivities were lowest in injuries of the pancreas (0%), intestinal tract (41.6%), and bladder (50%). False negative scans occurred in 1.9 per cent of patients, with no deaths or major complications attributable to delay in diagnosis. Nonoperative management was possible in 72 per cent of 57 patients with solid viscus injuries; splenic preservation was possible in 81.5 per cent of injured organs. Urine dipsticks and urinalysis performed poorly as predictors of either significant urological injury or intra-abdominal injury in general. When indications included early need for nonabdominal operation, only three of 41 scans were positive. Yield for patients scanned with obtundation as an isolated indication was diminished. Cost of CTA exceeds that of DPL, but lower procedure-related risk and lower estimated rate of nontherapeutic laparotomy leads to clinical favor of CTA in this group of patients.