Abdominal computed tomography for the diagnosis of intra-abdominal sepsis in critically injured patients - Fishing in murky waters

Hypothesis: Abdominal computed tomographic (ACT) scans are useful in the ev aluation of sepsis of unknown origin in patients with major trauma. Design: Prospective case series of consecutive patients. Setting: Intensive care unit of level I academic trauma center. Patients: Eighty-five critically injured patients admitted to the intensive care unit in 32 months (6% of all intensive care unit admissions) who deve loped sepsis of unknown origin. Interventions: One hundred sixty-one ACT scans. Main Outcome Measures: Sensitivity and specificity of the ACT scans, number of patients subjected to changes in treatment following an ACT scan. Results: Forty-nine patients (58%) had an intraabdominal focus of infection identified on ACT scan. Penetrating trauma and emergent laparotomy were th e only independent factors associated with abnormal findings on ACT scan. T he sensitivity and specificity of the test were 97.5% and 61.5%, respective ly. Overall, 59 patients (69%) benefited from treatment changes after an AC T scan. Conclusion: Abdominal computed tomographic scans reliably identify intra-ab dominal foci of infection in patients with major trauma evaluated for sepsi s of unknown origin.