M. A. Brooke1, G. P. Victorino1 1University Of California – San Francisco,General Surgery,San Francisco, CA, USA
Introduction: Computed tomography (CT) imaging has an established role in the initial evaluation of blunt abdominal trauma. What is less clear is the role of CT in guiding delayed exploration in patients initially managed non-operatively. Our hypothesis was that repeat CT would accurately identify the need for an exploratory laparotomy in this clinical situation.
Methods: From 2005-2014, we reviewed all blunt abdominal trauma patients at our institution who received an admission CT scan. We identified 52 patients who underwent repeat CT of the abdomen within 72 hours for the documented, specific purpose of re-evaluating potential intra-abdominal injuries. CT findings were categorized into either presence or absence of an indication for exploration based on the CT, allowing a sensitivity analysis.
Results: Of the 52 patients who met our inclusion criteria, 9 underwent surgical exploration of the abdomen and 43 did not. Three of the explorations were negative for significant intra-abdominal injuries. Admission clinical indicators such as GCS, ISS, and AIS were not statistically different between the operative and non-operative groups. The second CT was performed significantly earlier after the first scan in patients who received an operation compared to the non-operative group (10.3 vs. 33.2 hours, p=0.003). Compared with initial abdominal CT scan, repeat CT scan was found to increase the sensitivity for the detection of an operative indication from 67 to 100%, while also improving the specificity, positive predictive value (PPV) and negative predictive value (NPV)(Table 1).
Conclusions: Repeat CT scan of the abdomen may be useful in evaluating blunt trauma patients initially managed non-operatively for delayed operative intervention. The second CT scan improves the sensitivity of CT evaluation to 100% while also increasing the specificity, PPV, and NPV. Repeat CT can help guide decision-making in those patients lacking clinical signs mandating exploration.
