Diagnostic yield and clinical utility of abdominopelvic ct following emergent laparotomy for trauma

Adam K. Haste, Brian L. Brewer, Scott Steenburg

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To determine the incidence of unexpected injuries that are diagnosed with computed tomography (CT) after emergent exploratory laparotomy for trauma and whether identification of such injuries results in additional surgery or angiography. Materials and Methods: This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. The trauma databases of two urban level 1 trauma centers were queried over a period of more than 5 years for patients who underwent abdominopelvic CT within 48 hours of emergent exploratory laparotomy for trauma. Comparisons were made between CT findings and those described in the surgical notes. Descriptive statistics were generated, and 95% confidence intervals (CIs) were determined by using an exact method based on a binomial distribution. Results: The study cohort consisted of 90 patients, including both blunt and penetrating trauma victims with a median injury severity score of 17.5 (interquartile range, 9.25-34). Seventy-three percent (66 of 90) of patients sustained penetrating trauma, 82% (74 of 90) of whom were male. A total of 19 patients (21.1%; 95% CI: 13.2, 31.0) had additional injuries within the surgical field that were not identified during laparotomy. There were 17 unidentified solid organ injuries, and eight patients had active bleeding within the surgical field. Eight patients (8.9%; 95% CI: 3.9, 16.8) had unexpected injuries at CT that were substantial enough to warrant additional surgery or angiography. In addition, previously undiagnosed fractures were found in 45 patients (50%; 95% CI: 39.3, 60.7). Conclusion: Performing CT after emergent exploratory laparotomy for trauma is useful in identifying unexpected injuries and confirming suspected injuries that were not fully explored at initial surgery.

Original languageEnglish (US)
Pages (from-to)735-742
Number of pages8
JournalRadiology
Volume280
Issue number3
DOIs
StatePublished - Sep 1 2016

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Laparotomy
Wounds and Injuries
Tomography
Confidence Intervals
Angiography
Binomial Distribution
Health Insurance Portability and Accountability Act
Injury Severity Score
Trauma Centers
Research Ethics Committees
Intraoperative Complications
Informed Consent
Cohort Studies
Retrospective Studies
Databases
Hemorrhage

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging

Cite this

Diagnostic yield and clinical utility of abdominopelvic ct following emergent laparotomy for trauma. / Haste, Adam K.; Brewer, Brian L.; Steenburg, Scott.

In: Radiology, Vol. 280, No. 3, 01.09.2016, p. 735-742.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the incidence of unexpected injuries that are diagnosed with computed tomography (CT) after emergent exploratory laparotomy for trauma and whether identification of such injuries results in additional surgery or angiography. Materials and Methods: This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. The trauma databases of two urban level 1 trauma centers were queried over a period of more than 5 years for patients who underwent abdominopelvic CT within 48 hours of emergent exploratory laparotomy for trauma. Comparisons were made between CT findings and those described in the surgical notes. Descriptive statistics were generated, and 95{\%} confidence intervals (CIs) were determined by using an exact method based on a binomial distribution. Results: The study cohort consisted of 90 patients, including both blunt and penetrating trauma victims with a median injury severity score of 17.5 (interquartile range, 9.25-34). Seventy-three percent (66 of 90) of patients sustained penetrating trauma, 82{\%} (74 of 90) of whom were male. A total of 19 patients (21.1{\%}; 95{\%} CI: 13.2, 31.0) had additional injuries within the surgical field that were not identified during laparotomy. There were 17 unidentified solid organ injuries, and eight patients had active bleeding within the surgical field. Eight patients (8.9{\%}; 95{\%} CI: 3.9, 16.8) had unexpected injuries at CT that were substantial enough to warrant additional surgery or angiography. In addition, previously undiagnosed fractures were found in 45 patients (50{\%}; 95{\%} CI: 39.3, 60.7). Conclusion: Performing CT after emergent exploratory laparotomy for trauma is useful in identifying unexpected injuries and confirming suspected injuries that were not fully explored at initial surgery.",
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