Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients.
BACKGROUND
The prompt detection and accurate localization of abdominal injuries are difficult. Some diagnostic modalities, including laboratory tests, ultrasound, and diagnostic peritoneal lavage (DPL) were used to evaluate patients with blunt abdominal trauma, with various advantages and pitfalls. We aimed to evaluate the risk and benefit of using multidetector computed tomography (MDCT) as an initial assessment tool for proper diagnosis and treatment planning of patients with blunt abdominal trauma.


METHODS
Two hundred fifty-two patients with blunt abdominal trauma were prospectively enrolled. Multidetector computed tomography was performed during resuscitation. The risk and benefit of using MDCT in the diagnosis and planning of treatment were analyzed.


RESULTS
The time required for a MDCT examination averaged 10.2 minutes. Of the studies done, 224 revealed abdominal injuries. Of those, 34 were performed in patients with unstable hemodynamic status without adverse effect. Prompt diagnosis and proper treatment were given according to the MDCT findings. A total of 43 (17.1%) MDCTs showed contrast extravasation. Active bleeding was confirmed in all and treated with transarterial embolization (30) or surgery (13). Another 58 patients sustained bowel, mesenteric, or pancreatic injuries (BMPI) necessitating laparotomy. The sensitivity, specificity, and accuracy of MDCT in identifying patients with active bleeding or BMPI were all 100%.


CONCLUSIONS
Multidetector computed tomography was useful as a second line initial assessment tool to identify injuries and determine treatment planning in blunt abdominal trauma patients. No increased risk was found if the facility is readily available, the protocol is well designed, and the patient is well prepared.
Fang
Jen-Feng
JF
Trauma and Critical Care Center, Department of Surgery, Chang-Gung Memorial Hospital, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taiwan. jimfang@adm.cgmh.org.tw
Wong
Yon-Cheong
YC
Lin
Being-Chuan
BC
Hsu
Yu-Pao
YP
Chen
Miin-Fu
MF
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery