The role of CT for indicating laparotomy in blunt abdominal trauma: comparing CT results and surgical findings in a group of 101 patients. Prospective study
Abstract
BACKGROUND: The helical contrast CT plays an important role in the management of abdominal trauma. For surgeons its reliability and utilization remain questionable.
Objective: The study aimed at correlating CT results at admission with surgical findings in patients undergoing laparotomy for blunt abdominal trauma, detecting CT sensitivity for therapeutic laparotomy and uncovering organ injury. The group of patients is from one hospital; therefore mistakes from different result interpretations or data collecting are not present.
METHOD: A rentgenologist's conclusion during patient admission, late independent CT evaluation by an experienced rentgenologist and surgical finding were statistically correlated. RESULTS: 101 out of 139 patients underwent laparotomy after initial CT.
Mean ISS were 27.8. CT sensitivity (SE) for indicating therapeutic laparotomy was 88.77/ 89.88%, predictive value positive result (PVPR) 92.94/94.11%, and false negativity (FN) 11.23/10.11 %.
SE in liver and spleen trauma was 88.76/95.50%, PVPR 96.34/93.41%, and FN 11.24%/ 4.50%. SE in bowel and mesenteric injury was 27.27/18.18 %, SE in diaphragm injury was 33.33 %.
CONCLUSION: the study presented high SE of CT forecasting therapeutic laparotomy for blunt abdominal trauma. The high SE of CT in liver and spleen injuries is useful in indicating conservative therapy.
The CT accuracy was not confirmed in bowel. mesenteric or diaphragm injury. It strongly recommend patient observation even with negative CT.