Usefulness of Multidetector Computed Tomography for the Initial Assessment of Blunt Abdominal Trauma Patients

• Published in: World journal of surgery Vol. 30; no. 2; pp. 176 - 182
• Main Authors: Fang, Jen‐Feng, Wong, Yon‐Cheong, Lin, Being‐Chuan, Hsu, Yu‐Pao, Chen, Miin‐Fu
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01.02.2006; Springer; Springer Nature B.V
• Subjects: Abdominal Injuries - diagnostic imaging; Abdominal Injuries - mortality; Abdominal Injuries - surgery; Abdominal Injury; Adolescent; Adult; Aged; Biological and medical sciences; Blunt Abdominal Trauma; Emergency Treatment; Female; Follow-Up Studies; General aspects; Humans; Injuries of the abdomen. Foreign bodies of the digestive system; Injury Severity Score; Laparotomy - methods; Laparotomy - mortality; Male; Medical sciences; Middle Aged; Pelvic Fracture; Portal Venous Phase; Risk Assessment; Sensitivity and Specificity; Survival Rate; Tomography, X-Ray Computed - methods; Transcatheter Arterial Embolization; Trauma Centers; Traumas. Diseases due to physical agents; Treatment Outcome; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - surgery; Human; Medicine; Abdominal trauma; Multidetector scanner; Treatment; Radiodiagnosis; Abdominal disease; Surgery; Medical imagery; Patient; Computerized axial tomography
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-005-0194-7

Background The prompt detection and accurate localization of abdominal injuries are difficult. Some diagnostic modalities, including laboratory tests, ultrasound, and diagnostic peritoneal lavage (DPL) were used to evaluate patients with blunt abdominal trauma, with various advantages and pitfalls. We aimed to evaluate the risk and benefit of using multidetector computed tomography (MDCT) as an initial assessment tool for proper diagnosis and treatment planning of patients with blunt abdominal trauma. Methods Two hundred fifty‐two patients with blunt abdominal trauma were prospectively enrolled. Multidetector computed tomography was performed during resuscitation. The risk and benefit of using MDCT in the diagnosis and planning of treatment were analyzed. Results The time required for a MDCT examination averaged 10.2 minutes. Of the studies done, 224 revealed abdominal injuries. Of those, 34 were performed in patients with unstable hemodynamic status without adverse effect. Prompt diagnosis and proper treatment were given according to the MDCT findings. A total of 43 (17.1%) MDCTs showed contrast extravasation. Active bleeding was confirmed in all and treated with transarterial embolization (30) or surgery (13). Another 58 patients sustained bowel, mesenteric, or pancreatic injuries (BMPI) necessitating laparotomy. The sensitivity, specificity, and accuracy of MDCT in identifying patients with active bleeding or BMPI were all 100%. Conclusions Multidetector computed tomography was useful as a second line initial assessment tool to identify injuries and determine treatment planning in blunt abdominal trauma patients. No increased risk was found if the facility is readily available, the protocol is well designed, and the patient is well prepared.