COMPUTED-TOMOGRAPHY IS INACCURATE IN ESTIMATING THE SEVERITY OF ADULTSPLENIC INJURY

Computed tomography (CT) is increasingly utilized in evaluation of adu lt splenic injury (SI), CT correlation with operative findings, CT rel ationship to successful nonoperative (NO) management, and CT reading r eproducibility were examined. Records of patients greater than or equa l to 15 years old admitted over a 3-year period were reviewed, Compute d tomography scans were graded by two radiologists blinded to clinical results, Computed tomography scans were performed on 49 of 77 patient s with SI, Eighteen underwent initial operation (OR) and 31 initial NO . Operative patients had higher Injury Severity Scores and Abdominal A bbreviated Injury Scale scores (p < 0.0001), Grade II readings predomi nated in the NO group (55%). Nonoperative management was successful fo r 9 grade III and 3 grade TV readings, Computed tomography matched OR grade in 10 readings, underestimated it in 18, and overestimated it in 6, Computed tomography missed SI in five patients, Radiologists disag reed on 9 of 45 (20%) scans. Computed tomography poorly predicted oper ative findings. Interobserver variability was common. SI management sh ould not be based solely on CT severity.