Abdominal CT scanning for trauma: how low can we go?

Purpose: computed tomography (CT) of the abdomen is an established, albeit expensive and perhaps overused, diagnostic modality for the evaluation of t he injured patient. We developed a practice management guideline for blunt abdominal trauma intended to reduce the percentage of negative CT scans, ye t minimize delayed recognition of injury and non-therapeutic laparotomy. Pr ocedures: between April 1996 and March 1997, 1147 adult patients at risk fo r blunt abdominal injury were admitted to our Level I trauma centre and und erwent abdominal evaluation according to the practice management guideline. Main Findings: abdominal CT was performed in 522 patients (45%), and 441 s cans were negative (85%). Delayed recognition of injury and non-therapeutic laparotomy rates were low, 4% and 1.6%, respectively. Principal Conclusion : abdominal CT scanning in trauma patients can achieve low non-therapeutic laparotomy and delayed recognition of injury rates but at the expense of hi gh negative CT scan rates. Greater reliance on the physical examination and perhaps abdominal ultrasound may reduce negative CT scan rates and yet pre serve low non-therapeutic laparotomy and delayed recognition of injury rate s. (C) 2000 Elsevier Science Ltd. All rights reserved.