Screening helical computed tomographic scanning in haemodynamic stable patients with transmediastinal gunshot wounds.
OBJECTIVE
The purpose of this study was to review and evaluate the efficacy of contrast-enhanced helical computed tomographic (CT) scanning in evaluating potential mediastinal injuries in stable patients with transmediastinal gunshot wounds (TMGSWs).


METHODS
During the review period, 01 January 2002-31 May 2005, the medical records of all haemodynamically stable patients with TMGSWs were retrieved and reviewed for demographics, diagnostic workup, treatment and complications. Screening CT was considered inconclusive in the presence of a mediastinal haematoma, pneumomediastinum or a missile track in proximity of major mediastinal structures. Inconclusive CT scans were further evaluated with angiography, and/or oesophography, and/or cardiac ultrasound.


RESULTS
Fifty consecutive haemodynamically stable patients with TMGSWs were identified. Thirty-five CT scans were performed, of which 29 (82.9%) were conclusive. Further diagnostic evaluation in the remaining six patients showed no injury. All patients were observed in a high-care unit and there were no missed injuries. The hospital charges generated with the CT scan based protocol were significantly less than with standard evaluation.


CONCLUSIONS
Contrast enhanced helical CT scanning is a safe, efficient and cost effective screening tool for evaluating haemodynamically stable patients with TMGSWs.
Ibirogba
Sheriff
S
Trauma Centre C-14, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
Nicol
Andrew J
AJ
Navsaria
Pradeep H
PH
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003287:Contrast Media; D003365:Costs and Cost Analysis; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D013019:South Africa; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging*
D003287:Contrast Media