title: Determining anatomic injury with computed tomography in selected torso gunshot wounds.
abstract: BACKGROUND
  Changes in the management of torso gunshot wounds (TGSWs) have evolved in recent years as a result of differences between military and civilian injuries and increasing interest in avoiding nontherapeutic invasive procedures. The objective of this study was to establish the utility and accuracy of computed tomography (CT) in the evaluation of selected patients with TGSWs.
  
  
  METHODS
  Retrospective review for a 6-year period of patients who sustained TGSWs and underwent CT solely for the purpose of trajectory determination. Patients had complete physical examinations and plain radiographic evaluations by a dedicated group of in-house trauma surgeons. When trajectory was indeterminate after evaluation, CT was performed. In some cases, CT was used when trajectory was determined to be intracavitary but organ injury was believed to be unlikely or amenable to nonoperative management.
  
  
  RESULTS
  Fifty TGSW patients underwent 52 computed tomographic scans. Abdominal/pelvic CT was performed in 37 patients, and thoracic CT was performed in 15 patients. All patients were stable and none sustained complications attributable to CT or delay in therapy. Twenty of 37 abdominal/pelvic computed tomographic scans excluded transabdominal or pelvic trajectory. Seventeen of 37 scans proved transabdominal or pelvic trajectory; nine laparotomies were performed, and eight patients were observed. Nine of 15 thoracic computed tomographic scans excluded transmediastinal trajectory. Six of 15 scans suggested vascular proximity and prompted further workup, which was positive in two cases.
  
  
  CONCLUSIONS
  CT of selected TGSW patients is safe and may reduce the incidence of invasive diagnostic procedures. A prospective evaluation of CT for TGSW patients is warranted.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Grossman
authors.forename: A K
authors.initials: AK
authors.lastname: May
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
authors.forename: P M
authors.initials: PM
authors.lastname: Reilly
authors.forename: D J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: M
authors.initials: M
authors.lastname: Rotondo
authors.forename: M B
authors.initials: MB
authors.lastname: Shapiro
authors.forename: D R
authors.initials: DR
authors.lastname: Kauder
authors.forename: H
authors.initials: H
authors.lastname: Frankel
authors.forename: H
authors.initials: H
authors.lastname: Anderson
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D003663:Decision Trees; D006801:Humans; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging*