LIMITING COMPUTED-TOMOGRAPHY TO PATIENTS WITH PERITONEAL LAVAGE-POSITIVE RESULTS REDUCES COST AND UNNECESSARY CELIOTOMIES IN BLUNT TRAUMA

Objective: To determine if computed tomographic (CT) scanning can be u sed to identify patients with blunt trauma, positive results of diagno stic peritoneal lavage (DPL), and a stable hemodynamic status who coul d be managed safely and cost-effectively without celiotomy. Design: Pa tients with blunt trauma who required an abdominal evaluation underwen t DPL. Patients with a red blood cell count greater than 10(11)/L (10( 5)/mm(3)) on lavage then underwent CT. Patients with solid organ injur y alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy. Results: Sixty-seven hemody namically stable patients had a red blood cell count greater than 10(1 1)/L on DPL; 38 patients underwent subsequent CT scanning, and 29 unde rwent immediate celiotomy in violation of the protocol. Eleven patient s in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P<.01). There were no deaths in either g roup. Because DPL is less expensive than CT, limiting CT to patients w ith DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580 594 over a period of 2 y ears. Conclusion: Limiting CT to the evaluation of patients with DPL-p ositive results and hemodynamic stability is safe, reduces charges, an d results in a lower rate of nontherapeutic celiotomies compared with DPL alone.