Abdominal Computed Tomography in Hypotensive Trauma Patients Delays Laparotomy and Increases Mortality
Authors urge caution in using this diagnostic tool for patients with blunt or penetrating trauma.
Computed tomography (CT) of the abdomen is being used increasingly in trauma patients, and, although it is highly accurate, its use in certain patients might delay definitive care, specifically laparotomy. To determine the risk that performing abdominal CT will delay laparotomy, researchers reviewed data from the National Trauma Data Bank from 2002 through 2006. Patients (age, above 14 years) with systolic blood pressure below 90 mm Hg on emergency department (ED) arrival and abdominal Abbreviated Injury Scale (AIS) score above 3 who underwent laparotomy within 90 minutes of ED arrival were included in the analysis. Patients transferred from other hospitals and those with significant brain injury (head AIS score above 3) were excluded.
Among 3218 patients, the median Injury Severity Score was 25, and the overall mortality rate was 32%; 446 patients (14%) underwent abdominal CT before laparotomy. The mortality rate was significantly higher in patients who underwent abdominal CT prior to laparotomy than in those who did not (44.8% vs. 29.5%). In logistic regression analysis, abdominal CT was independently associated with risk for death (odds ratio, 1.71), especially among patients who underwent laparotomy within 30 minutes after ED arrival (OR, 7.6).
The authors did not assess the influence of ultrasound, diagnostic peritoneal lavage, or presence of pelvic fracture on surgical decision making. However, these findings reinforce that abdominal CT generally is not indicated for hypotensive patients with penetrating trauma or hypotensive patients with blunt trauma and a positive ultrasound or peritoneal lavage result and no pelvic fracture.
John A. Marx, MD, FAAEM
Published in Journal Watch Emergency Medicine March 11, 2011
Citation(s): Neal MD et al. Over reliance on computed tomography imaging in patients with severe abdominal injury: Is the delay worth the risk? J Trauma 2011 Feb; 70:278.