title: Limiting computed tomography to patients with peritoneal lavage-positive results reduces cost and unnecessary celiotomies in blunt trauma.
abstract: OBJECTIVE
  To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy.
  
  
  METHODS
  Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 10(11)/L (10(5)/mm3) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy.
  
  
  RESULTS
  Sixty-seven hemodynamically stable patients had a red blood cell count greater than 10(11)/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P < .01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580,594 over a period of 2 years.
  
  
  CONCLUSIONS
  Limiting CT to the evaluation of patients with DPL-positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of nontherapeutic celiotomies compared with DPL alone.
authors.affiliation: Department of Surgery, Harborview Medical Center, Seattle, Wash., USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: L M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: P
authors.initials: P
authors.lastname: Rhee
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: R V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000191:economics; D000328:Adult; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D010533:Peritoneal Lavage; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000191:economics