title: Hypotension does not always make computed tomography scans unfeasible in the management of blunt abdominal trauma patients.
abstract: BACKGROUND
  Computed tomography (CT) scans have been used worldwide to evaluate patients with blunt abdominal trauma (BAT). However, CT scans have traditionally been considered to be a part of a secondary survey that can only be performed after the patient's haemodynamics have stabilised. In this study, we attempted to evaluate the role of the CT scan in managing BAT patients with hypotension.
  
  
  METHODS
  Patients who fulfilled the criteria for a major torso injury in our institution were treated according to the Advanced Trauma Life Support guidelines. The selection of diagnostic modalities for patients with stable and unstable haemodynamics was discussed. Furthermore, patients with hypotension after resuscitation who were administered haemostasis procedures were the focus of our analysis. We also delineated the influence of CT scans on the time interval between arrival and definitive treatment for these patients.
  
  
  RESULTS
  During the study period, 909 patients were enrolled in this study. Ninety-one patients (10.0%, 91/909) had a systolic blood pressure (SBP) <90mmHg after resuscitation. Fifty-eight of the patients (63.7%) received CT scans before they received definitive treatment. There was no significant difference in the CT scan application rate between the patients with and without hypotension after resuscitation (63.7% vs. 68.8%, p=0.382). Among the 79 patients with hypotension after resuscitation who underwent a haemostasis procedure (surgery or angioembolisation), there was no significant difference in the time between arrival and definitive haemostasis between the patients who received CT scans and those who did not (surgery: 57.8 (standard deviation (SD) 6.4) vs. 61.6 (SD 14.5)min, p=0.218; angioembolisation: [147.0 (SD 33.4) vs. 139.3 (SD 16.7)min, p=0.093).
  
  
  CONCLUSIONS
  The traditional priority of diagnostic modalities used to manage BAT patients should be reconsidered because of advancements in facilities and understanding of BAT. With shorter scanning times and transportation distances, hypotension does not always make performing a CT scan unfeasible.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: m7205@cgmh.org.tw.
authors.forename: Shang-Ju
authors.initials: SJ
authors.lastname: Yang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: surgymet@gmail.com.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: linbc@cgmh.org.tw.
authors.forename: Being-Chuan
authors.initials: BC
authors.lastname: Lin
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: sckang@adm.cgmh.org.tw.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: shangyusubmit@gmail.com.
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: kcyuan@cgmh.org.tw.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yuan
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: detv090@gmail.com.
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ouyang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: yupao@cgmh.org.tw.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Blunt abdominal trauma; Computed tomography scan; Hypotension