Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan.
BACKGROUND
Surgical decision-making in torso trauma is complex. This paper looks at the role of the computed tomography (CT) scan in this decision-making process.


METHODS
Patients with significant torso trauma (high velocity gunshot wound [HVGSW], blast, stab) admitted to a military role 2 (enhanced) hospital facility during a 7-week period of Operation HERRICK 9 (Afghanistan, October to November 2008) are reported. The management of those patients undergoing a CT scan as part of the decision-making process at the time of admission is discussed.


RESULTS
Twenty eight patients with significant torso trauma were admitted to the facility during the study period; HVGSW (n = 15), blast (n = 9), stab (n = 4). Thirteen patients underwent a CT scan as part of the surgical decision-making process; HVGSW (n = 5), blast (n = 8). Imaging confirmed torso integrity in 12 patients, one of whom subsequently had a laparotomy for vascular control for on-table haemorrhage during lower limb surgery. One patient had a confirmed thoraco-abdominal injury, which was treated conservatively with tube thoracostomy and 'active observation'.


CONCLUSIONS
A CT scan formed part of the surgical decision-making process in about half of the patients admitted with significant torso trauma, and helped prevent unnecessary laparotomy in this forward military environment. Those patients with a blast injury were more likely to undergo CT scanning than those where the mechanism of injury was a HVGSW.
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK. jasonesmith@doctors.org.uk
J E
JE
Smith
M
M
Midwinter
A W
AW
Lambert
D055826:Afghan Campaign 2001-; D003657:Decision Making; D006801:Humans; D008297:Male; D008889:Military Personnel; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000601:surgery