title: Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study.
abstract: OBJECTIVE
  Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined.
  
  
  METHODS
  This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation. The primary outcome measures were operative findings and clinical follow-up. CT results were compared with the primary outcome measures.
  
  
  RESULTS
  Of one hundred and seventy-one patients (72 gunshot wounds, 99 stab wounds; age range, 18-57 years; median age, 28 years) with penetrating torso trauma who underwent CT, 45 % were followed by an operation and 55 % by clinical follow up. Thirty-five patients had a gastrointestinal injury at surgery. The sensitivity, specificity, and accuracy of CT for diagnosing a gastrointestinal injury for all patients were each 91 %, and for predicting the need for surgery, they were 94 %, 93 %, 93 %, respectively. Among the 3 % of patients who failed observation, 1 % had a gastrointestinal injury.
  
  
  CONCLUSIONS
  CT is a useful technique to diagnose gastrointestinal injury following penetrating torso injury. CT can help discriminate patients requiring observation or surgery.
  
  
  CONCLUSIONS
  • The most sensitive sign is wound tract extending up to gastrointestinal wall. • The most accurate sign is gastrointestinal wall thickening. • Triple-contrast CT is a useful technique to diagnose gastrointestinal injury. • Triple-contrast CT helps to discriminate patients requiring observation and surgery.
authors.affiliation: Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Nitima
authors.initials: N
authors.lastname: Saksobhavivat
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA. kshanmuganathan@umm.edu.
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Boscak
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Clint W
authors.initials: CW
authors.lastname: Sliker
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Krystal
authors.initials: K
authors.lastname: Archer-Arroyo
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Miller
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Thorsten R
authors.initials: TR
authors.lastname: Fleiter
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Melvin T
authors.initials: MT
authors.lastname: Alexander
authors.affiliation: Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods / Q000592:standards*; D010808:Physical Examination; D011446:Prospective Studies; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000175:diagnosis; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging*; D014951:Wounds, Stab / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Gastrointestinal tract; Injuries; Multidetector computed tomography; Penetrating; Wounds, stab