Index CT-Based Scoring Systems in Operative Blunt Bowel and Mesenteric Injury Identification

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Abdominal Trauma

Background:

• Blunt bowel and mesenteric injury (BBMI) surgical management is challenging.
• Existing scoring systems like Faget and Bowel Injury Prediction Score (BIPS) aim to guide surgical decisions.
• Efficacy of these scores in predicting operative intervention needs further investigation.

Purpose of the Study:

• To evaluate the efficacy of the Faget score and BIPS in determining the need for surgery in patients with BBMI.
• To compare the accuracy of retrospective scoring system application versus direct radiologist review of CT scans.

Main Methods:

• Retrospective review of adult blunt trauma patients with BBMI at a Level 1 trauma center (2009-2019).
• Analysis of patients with preoperative CT scans.
• Retrospective calculation of Faget and BIPS CT scores from reports and independent radiologist review of images for BIPS.

Main Results:

• Of 91 BBMI patients, 62 met inclusion criteria.
• Retrospective Faget score: Sensitivity 39.1%, Specificity 81.2%, PPV 85.7%.
• Retrospective BIPS score: Sensitivity 47.8%, Specificity 87.5%, PPV 91.7%.
• Attending radiologist BIPS review: Sensitivity 56.5%, Specificity 93.7%, PPV 96.3%.

Conclusions:

• Existing BBMI scoring systems show limited sensitivity but high positive predictive value for operative intervention.
• Direct radiologist review of CT images using BIPS enhances accuracy compared to retrospective scoring of reports.