Blunt Trauma Abdominal and Pelvic Computed Tomography Has Low Yield for Injuries in More Than One Anatomic Region

Most trauma centers order abdominal and pelvic computed tomography (CT) as an automatically paired CT for adult blunt trauma evaluation. However, excessive CT utilization adds risks of excessive exposure to ionizing radiation, the need to work up incidental findings (leading to unnecessary and invasive tests), and greater costs. Examining a cohort of adult blunt trauma patients that received paired abdominal and pelvic (A/P) CT, we sought to determine the diagnostic yield of clinically significant injuries (CSI) in the following: 1) the abdomen alone; 2) the pelvis alone; 3) the lumbosacral spine alone; and 4) more than one of these anatomic regions concomitantly.

In this retrospective study, we reviewed the imaging and hospital course of a consecutive sample of blunt trauma activation patients older than 14 years of age who received paired A/P CT during their blunt trauma assessments at an urban Level I trauma center from April through October 2014. Categorization of CSI was determined according to an a priori, expert panel-derived classification scheme.

The median age of the 689 patients who had A/P CT was 48 years old; 68.1% were male; 64.0% were admitted, and hospital mortality was 3.6%. CSI yields were as follows: abdomen 2.2% (95% confidence interval [CI] [1.3-3.6%]); pelvis 2.9% (95% CI [1.9-4.4%]); lumbosacral spine 0.6% (95% CI [0.2-1.5%]); both abdomen and pelvis 0.3% (95% CI [0.1-1.1%]); both the abdomen and lumbosacral spine 0.6% (0.2-1.5%); both the pelvis and lumbosacral spine 0.1% (0.0-0.8%); all three regions - abdomen, pelvis and lumbosacral spine - 0.1% (0.0-0.8%).

Automatic pairing of A/P CT has very low diagnostic yield for CSI in both the abdomen and pelvis. These data suggest a role for selective CT imaging protocols that image these regions individually instead of automatically as a pair.