CT in Blunt Trauma Part 2

Here is a summary of some articles that question the use of pan CT for blunt abdominal trauma. Take a look back at CT in Blunt Trauma which argues that every blunt trauma patient should receive a pan CT scan.

Prospective study of 162 hemodynamically stable (SBP>90) patients with GCS >14 without neurologic injury and negative findings on physical examination for abdominal, pelvic or rib injury were scanned. There were 2 missed abdominal injuries a grade I splenic laceration and a bowel mesenteric hematoma. Neither required transfusion or surgical intervention. The study concluded that physical examination may be a reliable method for the identification of surgically significant abdominal injury.

Prospective study of 196 blunt abdominal trauma patients of which 22 patients had intraabdominal injury. 18 of the 22 patients had tenderness on exam. Of the 4 patients missed with exam one was subsequently intubated for a closed head injury, 2 had hematuria and one had rib fractures. The authors concluded that CT should be reserved for patients with abdominal tenderness or whose examination results are unreliable (ie, distracting injuries, head trauma with GCS score of <15, intoxication, pediatrics, mental illness). The specificity and negative predictive value of the abdominal examination is improved by the presence of hematuria. Following these rules may decrease the number of scans.

Gonzalez RP, Han M, Turk B, Luterman A.Screening for abdominal injury prior to emergent extra-abdominal trauma surgery: a prospective study. J Trauma. 2004 Oct;57(4):739-41.

Richards JR, Derlet RW. Computed tomography for blunt abdominal trauma in the ED: a prospective study. Am J Emerg Med. 1998 Jul;16(4):338-42.

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