Predicting the results and outcome of patients who undergo abdominal CT scanning while in the surgical intensive care unit

Postlaparotomy patients who remain in the Surgical Intensive Care Unit (SICU) are frequently suspected of harboring an intra-abdominal abscess (IAA). Computed Tomography (CT) of the abdomen has been advanced as an accurate method to diagnose an IAA. To determine the clinical parameters predictive of...

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Bibliographic Details
Published inThe American surgeon Vol. 59; no. 9; p. 610
Main Authors McLean, T R, Thornby, J, Svensson, L G
Format Journal Article
LanguageEnglish
Published United States 01.09.1993
Subjects
Abscess - diagnostic imaging
Abscess - etiology
Abscess - mortality
Abscess - therapy
Humans
Intensive Care Units
Laparotomy
Middle Aged
Postoperative Complications - diagnostic imaging
Radiography, Abdominal
Retrospective Studies
Severity of Illness Index
Survival Rate
Tomography, X-Ray Computed
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Summary:Postlaparotomy patients who remain in the Surgical Intensive Care Unit (SICU) are frequently suspected of harboring an intra-abdominal abscess (IAA). Computed Tomography (CT) of the abdomen has been advanced as an accurate method to diagnose an IAA. To determine the clinical parameters predictive of CT scan results, and the survival of such patients, this study reviewed a consecutive series of 29 postlaparotomy patients who were evaluated by abdominal CT scan while in the SICU. An IAA was identified significantly more frequently by CT when patients were explored for a GI malignancy (70% vs 30%; P < 0.05) and when patients were operated upon electively (11.1% vs 20.0%; P < 0.05). Postoperatively, alert patients were significantly more likely to have a CT scan positive for an IAA than were patients who were lethargic or nonresponsive (90% vs 10%; P < 0.05). Laboratory data, including radiographic studies, were not predictive of the CT scan results. A negative CT scan modified therapy in only 10.5 per cent of patients, while a positive scan altered therapy in 70 per cent of patients (P < 0.05). The overall survival for this group was 48.1 per cent. The identification of an IAA by CT scan did not significantly improve survival (42% with an IAA vs 40% without an IAA). APACHY II scores were significantly increased in nonsurvivors (17.4 +/- 6.0 survivors vs 23.76 +/- 7.8 nonsurvivors; P < 0.05). Our data indicate that in critically ill postlaparotomy SICU patients who were evaluated by abdominal CT scanning, there are some clinical clues that tend to predict whether or not CT scanning will identify an IAA.
ISSN:0003-1348