title: Triple-contrast CT scans in penetrating back and flank trauma.
abstract: Triple-contrast CT scanning (3-CT) is a diagnostic modality that has been introduced recently for the work-up of patients with penetrating injuries to the back or flank. Triple-contrast CT consists of giving oral, intravenous (IV), and rectal contrast medium. Our hypothesis was that this test is an accurate predictor of the absence of a retroperitoneal injury requiring surgical repair. We prospectively enrolled 88 clinically stable patients who sustained penetrating wounds to the back or flank. Seventy-eight received a diagnostic peritoneal lavage (DPL) before 3-CT. The scans were classified according to the risk of a retroperitoneal injury requiring repair. Patients who did not go to the operating room (OR) were observed for 48 hours. Of 88 patients entered, nine had high-risk scans, five of these patients underwent exploratory laparotomy, two of whom had significant injuries. Seventy-nine patients had non-high-risk scans. Seventy-seven were observed without complication, and two were explored for positive DPL, with no significant lesion found. The negative predictive value of a low- or moderate-risk 3-CT scan is 100% +/- 11%.
authors.affiliation: Department of Surgery, Cook County Hospital, Chicago, Illinois 60612.
authors.forename: R G
authors.initials: RG
authors.lastname: Himmelman
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.forename: S
authors.initials: S
authors.lastname: Gilkey
authors.forename: J A
authors.initials: JA
authors.lastname: Barrett
mesh_terms: D001415:Back / Q000000981:diagnostic imaging; D019567:Back Injuries; D003287:Contrast Media / Q000008:administration & dosage*; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000601:surgery; D014951:Wounds, Stab / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine; D007472:Iohexol