Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management.
BACKGROUND
Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown.


METHODS
Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded.


RESULTS
One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning.


CONCLUSIONS
Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.
Velmahos
George C
GC
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, Los Angeles County/University of Southern California Medical Center, Los Angeles, California 90033, USA. velmahos@usc.edu
Constantinou
Constantinos
C
Tillou
Areti
A
Brown
Carlos V
CV
Salim
Ali
A
Demetriades
Demetrios
D
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D003106:Colon / Q000293:injuries; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries; D007902:Length of Stay; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013154:Spleen / Q000293:injuries; D013270:Stomach / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000628:therapy