The role of negative CT of the abdomen and pelvis in the decision to admit adults from the emergency department after blunt trauma.
OBJECTIVE
Computed tomography (CT) is widely used in the initial evaluation of blunt trauma patients and is associated with a high rate of negative imaging. A described benefit of negative imaging is prompt discharge. This study examined a single level 1 trauma center to determine whether adult blunt trauma patients are discharged from the emergency department (ED) after negative CT of the abdomen and pelvis (CT AP).


METHODS
The authors retrospectively created a data set of adult blunt trauma patients who received CT AP in the ED from August to November 2003. Statistical analysis of admission rates on the basis of positivity or negativity on CT AP was performed to determine if the test influenced admission rates. Additional subgroup analysis was made between the patients admitted with negative CT AP and those who were discharged from the ED.


RESULTS
Two thirds (316/469) had negative CT AP. Whereas 80.4% of the patients (254/316) with negative CT AP were admitted, 98.0% (148/151) with positive CT AP were admitted, a statistically significant difference in admission rate (P < .0001). The vast majority (208/254, 81.9%) of patients with negative CT AP were admitted for extra-abdominal injuries. There was no statistical difference in the characteristics of a subgroup of 45 patients who were admitted without any documented injuries from the group discharged from the ED in terms of age, gender, comorbidity, Glasgow Coma Scale score, or intoxication.


CONCLUSIONS
Under current practice, negative CT AP after blunt trauma results in a statistically significant decrease in admissions.
Heilbrun
Marta E
ME
Wake Forest University School of Medicine, Department of Radiology, Winston-Salem, NC 27157, USA. mheilbru@wfubmc.edu
Chew
Felix S
FS
Tansavatdi
Katharine R
KR
Tooze
Janet A
JA
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D000328:Adult; D000368:Aged; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000293:injuries; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000628:therapy