THE USE OF COMPUTED-TOMOGRAPHY IN BLUNT ABDOMINAL INJURIES

A retrospective study was performed to evaluate the use of abdominopel vic computed tomography of the abdomen (CTA) in the initial evaluation of hemodynamically stable blunt trauma patients. Two hundred fifty-si x of 2,047 injury admissions over a 2-year period underwent CTA. Sixty -two (24.2%) scans were positive for visceral injury. Sensitivity of C TA for patients with visceral injury was 92.4 per cent, specificity wa s 99.5 per cent, and overall accuracy was 97.6 per cent. Of all injuri es documented by CTA or laparotomy, CTA detected 83.7 per cent. Injury -specific sensitivities were lowest in injuries of the pancreas (0%), intestinal tract (41.6%), and bladder (50%). False negative scans occu rred in 1.9 per cent of patients, with no deaths or major complication s attributable to delay in diagnosis. Nonoperative management was poss ible in 72 per cent of 57 patients with solid viscus injuries; splenic preservation was possible in 81.5 per cent of injured organs. Urine d ipsticks and urinalysis performed poorly as predictors of either signi ficant urological injury or intra-abdominal injury in general. When in dications included early need for nonabdominal operation, only three o f 41 scans were positive. Yield for patients scanned with obtundation as an isolated indication was diminished. Cost of CTA exceeds that of DPL, but lower procedure-related risk and lower estimated rate of nont herapeutic laparotomy leads to clinical favor of CTA in this group of patients.