The use of delayed computerized tomography in the evaluation of blunt abdominal trauma: A preliminary report

This purpose of this study was to analyze the use of abdominal computed tom ography (CT) imaging in patients with possible blunt abdominal trauma. A re trospective analysis of all trauma patients over a 1-year period (1993-1994 ) was conducted, with prospective study protocol in 52 patients using seria l abdominal exam and hematocrits (Hcts) instead of abdominal CT for evaluat ion of blunt abdominal trauma. Urgent abdominal CT was used as the initial diagnostic test for evaluation of blunt abdominal trauma in 813 patients ov er this 1-year period. CT was obtained in 379 (46.6%) of these patients who arrived hemodynamically stable (admission systolic blood pressure greater than or equal to 90), had a Glasgow Coma Scale > 13, and had admission Hct greater than or equal to 35 because of distracting injuries, possible traum atic brain injury, or alcohol/drug use, which might render the abdominal ph ysical exam unreliable, Only 47 CT scans (12.4%) were positive, and three p atients (0.8%) required laparotomy. In an effort to more efficiently use ab dominal CT, we performed a prospective study in 52 patients with possible b lunt abdominal trauma, admission systolic blood pressure greater than or eq ual to 90, Hct greater than or equal to 35, Glasgow Coma Scale > 13, and a normal abdominal exam on admission. These patients were followed with seria l:abdominal examinations and Hcts every 6 hours for 24 hours, and delayed C T, when applicable. CT was obtained in seven patients (13.5%) for evaluatio n of fall in Hct or abnormal abdominal examination; all were negative for a bdominal injury. A protocol using serial abdominal exams, Hcts, and delayed abdominal CT imaging may be useful in select patients to decrease the high number of negative routine abdominal CTs that are obtained in the evaluati on of blunt abdominal trauma.