ABDOMINAL COMPUTED-TOMOGRAPHY SCAN AS A SCREENING TOOL IN BLUNT TRAUMA

Background. One of the most difficult problems in blunt trauma is eval uation for potential intraabdominal injury. Admission for serial abdom inal exams remains the standard of care after intraabdominal injury ha s been initially excluded. We hypothesized a normal abdominal computed tomography (CT) scan in a subgroup of minimally injured patients woul d obviate admission for serial abdominal examinations, allowing safe d ischarge from the emergency department (ED). Methods. We reviewed our blunt trauma experience with patients admitted solely for serial abdom inal examimations after a normal CT. Patients were identified from the trauma registry at a Level I trauma center from July 1991 through Jun e 1995. Patients with abnormal CTs, extraabdominal injuries necessitat ing admission, hemodynamic abnormalities, a Glasgow Coma Scale less th an 13, or injury severity scores (ISSs) greater than 15 were excluded. Records of 238 patients remained; we reviewed them to determine the p resence of missed abdominal injury. Results, None of the 238 patients had a missed abdominal injury. Average ISS of these patients was 3.2 ( range, 0 to 10). Discharging these patients from the ED would result i n a yearly cost savings of $32,874 to our medical system. Conclusions. Abdominal CT scan is a safe and cost-effective screening tool in pati ents with blunt trauma. A normal CT scan in minimally injured patients allows safe discharge from the ED.