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Computed tomography for blunt abdominal trauma in the ED: a prospective study
1Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA.
The American Journal of Emergency Medicine
|July 22, 1998
Summary
Early abdominal computed tomography (CT) effectively screens stable blunt trauma patients for intra-abdominal injury (IAI). Combining abdominal tenderness and hematuria is a reliable indicator for CT scans, potentially reducing unnecessary admissions.
Area of Science:
- Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Blunt abdominal trauma evaluation requires accurate diagnostic criteria.
- Identifying patients with intra-abdominal injury (IAI) is crucial for timely intervention.
- Computed tomography (CT) is a key diagnostic tool in trauma care.
Purpose of the Study:
- To establish criteria for ordering abdominal CT in stable blunt trauma patients.
- To identify high-risk patients for IAI using physical exam, hematocrit, and urinalysis.
- To assess the impact of early CT scanning on hospital admissions.
Main Methods:
- Prospective evaluation of 196 stable blunt trauma patients in an emergency department.
- Data collection included physical findings, hematocrit, hematuria, and Glasgow Coma Scale score.
- Patient outcomes were followed until discharge to determine IAI and need for surgery.
Main Results:
- Twenty-two patients (11.2%) had IAI, with 8 requiring surgery, all presenting with abdominal tenderness.
- Combined abnormal abdominal exam and hematuria showed 64% sensitivity and 94% specificity for IAI.
- Early CT scanning averted 40 potential trauma admissions, but carries a risk of overuse.
Conclusions:
- Early CT scanning is an effective screen for IAI in stable blunt trauma patients.
- Abdominal tenderness and hematuria are significant indicators for CT imaging.
- CT's benefit is questionable for patients without tenderness or with isolated hematocrit decrease.