The role of computed tomography after emergent trauma operation

Although computed tomography (CT) has become the preferred diagnostic modality, immediate surgical intervention is often required for severely injured patients with minimum preoperative radiographic evaluation. The utility of postoperative CT (postop-CT) for the identification of undiagnosed injuries and its impact on patient management remain unclear. The purpose of this study was to evaluate the utility of postop-CT for the identification of clinically significant injuries in patients who underwent an emergent life-saving procedure.

A 5-y retrospective study from 2009 to 2013 was conducted at a high-volume level I trauma center. We included blunt and penetrating trauma patients who underwent an emergent operation (neck exploration, thoracotomy, and laparotomy) without preoperative CT. Postop-CT was obtained within 48 h after the initial operation at the discretion of the attending trauma surgeon. Characteristics of newly diagnosed injuries on postop-CT were analyzed. These injuries were considered clinically significant when the patient required (1) immediate intervention; (2) new consultation from a specialty service; or (3) a higher level of care.

A total of 89 patients met our inclusion criteria (five neck explorations, 16 thoracotomies, and 74 laparotomies) with the following characteristics: median age of 30 y, 87.6% male, 47.2% penetrating injury, and median injury severity score of 24. New injuries were identified on postop-CT in 59 cases (66%), and clinical management was changed in 51 cases (57%). Patients with an admission Glasgow Coma Scale <15 and solid organ injury identified during the index operation were more likely to have new injuries on postop-CT.

In patients undergoing an emergent operation before having their full diagnostic workup completed, postop-CT often demonstrates clinically significant injuries. Further prospective study to identify the patients who will benefit from postop-CT is warranted.