The role of computed tomography in blunt abdominal trauma.

OBJECTIVE

To determine the utility of the computed tomography (CT) scan in blunt abdominal trauma and to compare it with operative findings or clinical outcomes.

METHODS

A retrospective analysis based on existing, diagnostic CT scan reports taken during a 5 year period from 245 consecutive patients with blunt abdominal trauma. Percentages and types of trauma identified were based on CT scan findings. Recorded data included age, sex, type of injuries and scan results. The CT findings were compared and correlated with the operative findings, or clinical follow-up in conservatively managed cases.

RESULTS

Of the total of 245 patients, 113 (46%) underwent surgery. One hundred and thirty two (54%) patients were conservatively managed. There were 12 (4.9%) deaths. Hemoperitoneum were detected in 170 patients. All 52 patients with small hemoperitoneum on CT scan were conservatively managed and all 22 patients with large hemoperitoneum required surgical exploration. There were 95 splenic, 63 renal, 48 hepatic and 13 pancreatic injuries. Twenty one patients had bowel injuries. Five patients had vascular injuries. Twenty three patients had multi-organ injuries. Organ injuries were graded using the OIS (Organ Injury Scale) guidelines.

CONCLUSION

In conjunction with close clinical monitoring, CT was reliable in the evaluation of blunt abdominal trauma in a selected group of patients, with overall sensitivity of 97% and specificity of about 95%. Positive predictive value 82% and negative predictive value 100%.