Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries.
OBJECTIVE
We describe the performance of helical abdominal computed tomography (CT) scan without oral contrast for the detection of blunt gastrointestinal injuries.


METHODS
We retrospectively reviewed the records of a consecutive series of patients who underwent helical abdominal CT scanning for evaluation of blunt intra-abdominal injury and were admitted to a Level I trauma center from May 1996 to September 2001. Abdominal CT scans were performed with intravenous contrast but without oral contrast. Patients were considered to have gastrointestinal injuries if an injury was identified to the gastrointestinal tract from the duodenum to the sigmoid colon or associated mesentery and considered to have major gastrointestinal injuries if gastrointestinal perforation, active mesenteric hemorrhage, or mesenteric devascularization occurred. All gastrointestinal injuries were confirmed by laparotomy, autopsy, or additional imaging studies.


RESULTS
Six thousand fifty-two patients underwent abdominal CT scan (mean age 35.5 +/- 21.1 years), and 106 (1.8%) patients had gastrointestinal injuries identified by laparotomy, autopsy, or additional (nonabdominal CT) imaging studies. Abdominal CT scan result was abnormal in 91 (86%; 95% confidence interval [CI] 78% to 92%) of the 106 patients with gastrointestinal injuries and revealed findings suggestive of gastrointestinal injury in 81 (76%; 95% CI 67% to 84%) patients. Abdominal CT scan demonstrated findings suggestive of gastrointestinal injury in 58 of 64 (91%; 95% CI 81% to 96%) patients with major gastrointestinal injuries. Two hundred thirty-eight (4.0%) patients had findings suspicious for gastrointestinal injuries on abdominal CT scan, but gastrointestinal injury was never confirmed.


CONCLUSIONS
Helical abdominal CT scan without oral contrast identified nearly three fourths of patients with blunt gastrointestinal injuries who were selected for abdominal CT scanning. Sensitivity of this diagnostic test improves in the subset of patients with major gastrointestinal injuries.
Holmes
James F
JF
Division of Emergency Medicine, Department of Internal Medicine, Sacramento, CA, USA. jfholmes@ucdavis.edu
Offerman
Steven R
SR
Chang
Cindy H
CH
Randel
Brad E
BE
Hahn
David D
DD
Frankovsky
Matthew J
MJ
Wisner
David H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D004064:Digestive System / Q000293:injuries*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal / Q000379:methods* / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods* / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging
D003287:Contrast Media