COMPUTED-TOMOGRAPHY FOR EVALUATING BLUNT ABDOMINAL-TRAUMA IN THE LOW-VOLUME NONDESIGNATED TRAUMA CENTER - THE PROCEDURE OF CHOICE

Background: Scepticism has been expressed regarding the accuracy of co mputed tomography for evaluating patients with blunt abdominal trauma in low-volume institutions. Diagnostic peritoneal lavage has been sugg ested as a more reliable method, and recently ultrasound has been prop osed as a quick alternative. We sought to determine the accuracy of co mputed tomography at our low-volume center, which lacks 24-hour, in-ho use computed tomography dedicated radiologists. Methods: A prospective case series of patients who had computed tomographic evaluation reque sted for suspected blunt abdominal trauma were enrolled over a 1-year study period. Results: Fifty-five patients were enrolled, Injuries wer e identified in 12 patients, six of whom required intervention. The di agnostic accuracies for the detection of injury were 86% and 90.5% for radiology residents and attending radiologists, respectively, The lik elihood ratios for the detection of an injury requiring intervention w ere identical for both groups of interpreters and were 0.17 for negati ve result and 35.6 for positive result. Conclusion: The accuracy of co mputed tomography for evaluating blunt abdominal trauma at a low-volum e institution is comparable to that reported from higher-volume center s and may be the procedure of choice, averting the expected higher inc idence of nontherapeutic laparotomy attendant with more widespread app lication of diagnostic peritoneal lavage and the missed injuries that may be expected from the occasional ultra-sonographer.