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Computed tomography and diagnostic peritoneal lavage. Complementary roles in blunt trauma
J W Meredith1, J A Ditesheim, S Stonehouse
1Division of Surgical Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27103.
The American Surgeon
|January 1, 1992
Summary
Computed tomography (CT) is more accurate than diagnostic peritoneal lavage (DPL) for evaluating blunt abdominal trauma in stable patients. CT reduced unnecessary laparotomies and inappropriate observations compared to DPL.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- The roles of computed tomography (CT) and diagnostic peritoneal lavage (DPL) in evaluating stable blunt abdominal trauma are debated.
- There is a need to clarify the independent and combined diagnostic value of CT and DPL.
Purpose of the Study:
- To prospectively compare the accuracy of CT and DPL in diagnosing injuries in hemodynamically stable adult patients with blunt torso trauma and equivocal abdominal exams.
Main Methods:
- A prospective study involving 116 adult patients with blunt torso trauma.
- Patients underwent CT scan, followed by DPL.
- Decisions for laparotomy were based on CT findings, DPL results, and combined information.
Main Results:
- CT scan led to unnecessary laparotomy in 0.8% of patients, while DPL led to unnecessary laparotomy in 15.5% (P > 0.01).
- Inappropriate observation was recommended by CT in 6.9% of patients, versus 1.7% by DPL (P < 0.01).
- Only 17 out of 22 initial laparotomies were required for injury repair.
Conclusions:
- CT is significantly more accurate than DPL in identifying the need for laparotomy in stable blunt abdominal trauma patients.
- CT minimizes both unnecessary surgeries and missed injuries compared to DPL.