title: Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial.
abstract: OBJECTIVE
  Blunt SBI is infrequent and its diagnosis may be difficult, especially in the face of confounding variables. The purpose of this study was to evaluate methods for making the diagnosis of blunt SBI.
  
  
  METHODS
  Patients with blunt small bowel injury (SBI) were identified from the registries of 95 trauma centers for a 2-year period (1998-1999). Patients with SBI (cases) were matched by age and Injury Severity Score with a blunt trauma patient receiving an abdominal workup who did not have SBI (controls).
  
  
  RESULTS
  Logistic regression models were unable to differentiate SBI with perforation from SBI without perforation. Thirteen percent of patients with documented perforating SBI had normal abdominal computed tomographic scans preoperatively.
  
  
  CONCLUSIONS
  Alone or in combination, current diagnostic approaches lack sensitivity in the diagnosis of perforated SBI. Improvements in diagnostic methods and approaches are needed to ensure the prompt diagnosis of this uncommon but potentially devastating injury.
authors.affiliation: Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042-3300, USA.
authors.forename: Samir M
authors.initials: SM
authors.lastname: Fakhry
authors.forename: Dorraine D
authors.initials: DD
authors.lastname: Watts
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
mesh_terms: D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D007421:Intestine, Small / Q000293:injuries*; D015337:Multicenter Studies as Topic; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality