Multi detector computed tomography imaging in penetrating injuries (original) (raw)
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Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan
Annals of The Royal College of Surgeons of England, 2010
INTRODUCTION Surgical decision-making in torso trauma is complex. This paper looks at the role of the computed tomography (CT) scan in this decision-making process. PATIENTS AND METHODS Patients with significant torso trauma (high velocity gunshot wound [HVGSW], blast, stab) admitted to a military role 2 (enhanced) hospital facility during a 7-week period of Operation HERRICK 9 (Afghanistan, October to November 2008) are reported. The management of those patients undergoing a CT scan as part of the decision-making process at the time of admission is discussed. RESULTS Twenty eight patients with significant torso trauma were admitted to the facility during the study period; HVGSW (n = 15), blast (n = 9), stab (n = 4). Thirteen patients underwent a CT scan as part of the surgical decision-making process; HVGSW (n = 5), blast (n = 8). Imaging confirmed torso integrity in 12 patients, one of whom subsequently had a laparotomy for vascular control for on-table haemorrhage during lower limb surgery. One patient had a confirmed thoraco-abdominal injury, which was treated conservatively with tube thoracostomy and 'active observation'. CONCLUSIONS A CT scan formed part of the surgical decision-making process in about half of the patients admitted with significant torso trauma, and helped prevent unnecessary laparotomy in this forward military environment. Those patients with a blast injury were more likely to undergo CT scanning than those where the mechanism of injury was a HVGSW.
International Journal of Clinical Trials, 2023
Trauma or injury is described as bodily harm occurred due to the energy exchange with the environment that exceeds the body's capacity for resistance. It is one of the leading cause of mortality in individuals who are under the age of 45 years. In this era, trauma is considered an "Unsolved epidemic" with an estimated death toll that is reportedly equivalent to that of cancer and cardiovascular disease combined. 1 In the United States, trauma ranks fourth among all causes of death for people of all ages and is the leading mortality cause in both men and women under the age of 45 years. In the health care system, trauma also has a significant financial impact, resulting in almost a third of all visits to emergency care and more than $80 billion in annual direct medical care expenses. 2 Trauma may result from assault, a road traffic accident, a fall from a height accidentally, a sports injury, or the ABSTRACT Background: The present study was conducted with the primary aim of evaluating the role of computed tomography imaging in the assessment of blunt abdominal trauma (BAT) and penetrating abdominal trauma injuries. Methods: This prospective study comprised 53 patients with BAT and PAT injuries referred from the emergency department to the department of radio-diagnosis for ultrasonography and CT. Multidetector computed tomography scans were performed on GE Bright Speed Elite 16 slice CT Scanner. The various injuries seen on the CT images were grouped and examined based on the injury site and the organs involved. Results: The majority of the study subjects, i.e., 17/53 (32.08%) belonged age group of 20-30 yrs. Out of the 53 study subjects, 48 had BAT and 5 had PAT. The majority of study subjects who had BAT, i.e., 26/48 RTA, was the cause of trauma, and 5 out of 5 who had PAT assault was the cause of trauma. The most common organ injured was the spleen (18), followed by the liver (17), bowel (15), Anterior abdominal wall (6), pancreas (1), Kidney (1), Uterus (2), Multiple organs (1) and Hemoperitoneum without solid organ injury (1). CT showed 100% accuracy in the diagnosis of abdominal organ injuries. Conclusions: CT imaging plays a pivotal role in the rapid identification of life-threatening injuries and is helpful for prompt initiation of appropriate care, which leads to an increase in the chance of survival of patients with BAT and PAT injuries.
Imaging of Penetrating Torso Trauma
Seminars in Roentgenology, 2016
This article is a wide spanning discussion of the radiologist's role in the multidisciplinary approach in evaluating and managing patients with penetrating injuries to the torso. Penetrating injuries to the chest, abdomen and pelvis can have a vast number of different presentations, depending on mechanism (ballistic or nonballistic injury) and the injury site. Many injuries to the different organ systems will have similar findings to one another, but have very different management strategies. This article discusses the basics of wound ballistics and injury patterns in penetrating torso injuries, the surgically relevant findings the trauma radiologist must be able to detect, and the most common findings in each organ system.
Prospective Evaluation of the Role of Computed Tomography in the Assessment of Abdominal Stab Wounds
JAMA Surgery, 2013
IMPORTANCE An important adjunct in the management of abdominal gunshot wounds, the role of computed tomography (CT) in the diagnostic workup of abdominal stab wounds remains controversial. OBJECTIVE To prospectively compare CT against serial physical examination in the evaluation of patients who have sustained a stab wound to the abdomen. DESIGN, SETTING, AND PATIENTS Prospective single-center observational study of all patients sustaining abdominal stab wounds from March 1, 2009, through March 31, 2011. Patients who were hemodynamically unstable, unevaluable, peritonitic, or eviscerated proceeded directly to laparotomy (n = 249). The remainder underwent CT evaluation. The impact of CT findings and physical examination on the decision to operate was analyzed.
World Journal of Surgery, 2011
Background Computed tomography (CT) scanning is a vital imaging technique in selecting patients for nonoperative management of civilian penetrating abdominal trauma. This has reduced the rate of nontherapeutic laparotomies and associated complications. Battlefield abdominal injuries conventionally mandate laparotomy, and with the advent of field deployable CT scanners it is unclear whether some ballistic injuries can be managed conservatively. Methods A retrospective 12 month cohort of patients admitted to a forward surgical facility in Afghanistan who sustained penetrating abdominal injury severe enough to warrant laparotomy or CT scan were studied. Patient details were retrieved from a prospectively maintained operative log and CT logs. Case notes were then reviewed and data pertaining to injury pattern, operative intervention, and survival were collected. Results A total of 133 patients were studied: 73 underwent immediate laparotomy (Lap group) and 60 underwent CT scanning (CT group). Of those undergoing CT scanning 17 underwent laparotomy and 43 were selected for nonoperative management. There were 15 deaths in the Lap group and none in the CT group. The median New Injury Severity and Revised Trauma Score was 29 and 7.55 in the Lap group and 9 and 7.8408 in the CT group, which is statistically significantly different (p \ 0.001). Five patients in the CT-Lap group had nontherapeutic laparotomies and 1 patient failed nonoperative management. Conclusions Computed tomography scanning can be used in stable patients who have sustained penetrating battlefield abdominal injury to exclude peritoneal breach and identify solid abdominal organ injury that can be safely managed nonoperatively.
Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT
Radiology, 2004
PURPOSE: To assess helical computed tomography (CT) with contrast material administered intravenously, orally, and rectally (triple contrast helical CT)) in the prospective evaluation of stable patients with abdominal gunshot wounds in whom there is no clinical indication for immediate exploratory laparotomy. MATERIALS AND METHODS: The study was conducted for 19 months. All patients met the following inclusion criteria: age of 16 years or older, hemodynamic stability, no clinical signs of peritoneal irritation, and signed consent to participate. Patients with obvious indications for laparotomy, such as gastrointestinal bleeding or evisceration, were excluded from the study. Forty-seven patients fulfilled the criteria and underwent abdominal triple-contrast helical CT. CT findings were evaluated by one of four radiologists for evidence of peritoneal penetration and injury to solid organs or hollow viscera. Patients were followed up clinically for 13 weeks. CT findings were compared with those at surgery and/or clinical follow-up. RESULTS: CT demonstrated abnormalities in 27 (57%) patients. Laparotomy was performed in 11 (23%) patients; 10 procedures were therapeutic and one was nontherapeutic. The remaining 20 patients had a negative CT scan. These patients were treated conservatively. One injury was missed at CT. For prediction of the need for laparotomy, sensitivity of CT was 96%; specificity, 95%; positive predictive value, 96%; negative predictive value, 95%; and accuracy, 96%.
Current concepts in imaging evaluation of penetrating transmediastinal injury
Radiographics : a review publication of the Radiological Society of North America, Inc
Penetrating transmediastinal injuries (TMIs) are injuries that traverse the mediastinum. These injuries are most commonly caused by firearms and knives. The investigation and management algorithms for TMI have undergone changes in recent years due to increasing evidence that computed tomography (CT) in useful in the evaluation of hemodynamically stable TMI patients. Initial investigation of TMI patients depends on the question of hemodynamic stability. In unstable patients, imaging (if any) should be limited to bedside radiography and focused ultrasonography. In hemodynamically stable patients in whom a mediastinal trajectory of injury is suspected, the primary imaging modality after radiography should be multidetector CT. CT is invaluable in the assessment of TMI due to its capacity to depict the injury track as well as demonstrate both direct and indirect signs of organ injury. On the basis of the suspected trajectory and specific findings, radiologists can play an essential role ...
Reevaluation of Diagnostic Procedures for Transmediastinal Gunshot Wounds
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
Background: Little controversy surrounds the treatment of hemodynamically unstable patients with transmediastinal gunshot wounds (TMGSWs). These patients generally have cardiac or major vascular injuries and require immediate operation. In hemodynamically stable patients, debate surrounds the extent and order of the diagnostic evaluation. These patients can be uninjured, or can have occult vascular, esophageal, or tracheobronchial injuries. Evaluation has traditionally often included angiography, bronchoscopy, esophagoscopy, esophagography, and pericardial evaluation (i.e., pericardial window) for all hemodynamically stable patients with TMGSWs. Expansion of the use of computed tomographic (CT) scanning in penetrating injury led to a modification of our protocol. Currently, our TMGSW evaluation algorithm for stable patients consists of chest radiograph, focused abdominal sonography for trauma, and contrast-enhanced helical CT scan of the chest with directed further evaluation. The purpose of this study is to evaluate the efficiency of contrast-enhanced helical CT scan for evaluating potential mediastinal injuries and to determine whether patients can be simply observed or require further investigational studies. Methods: Medical records of hemodynamically stable patients admitted with TMGSWs over a 2-year period were reviewed for demographics, mechanism of injury, method of evaluation, operative interventions, injuries, length of stay, and complications. CT scans were considered positive if they contained a mediastinal hematoma or pneumomediastinum, or demonstrated proximity of the missile track to major mediastinal structures. Results: Twenty-two stable patients were studied. CT scans were positive in seven patients. Directed further diagnostic evaluation in those seven patients revealed two patients who required operative intervention. Sixty-eight percent of patients had negative CT scans and were observed in a monitored setting without further evaluation. There were no missed injuries. The hospital charges generated with the CT scan-based protocol are significantly less than with the standard evaluation. Conclusion: Contrast-enhanced helical CT scanning is a safe, efficient, and cost-effective diagnostic tool for evaluating hemodynamically stable patients with mediastinal gunshot wounds. Positive CT scan results direct the further evaluation of potentially injured structures. Patients with negative results can safely be observed in a monitored setting without further evaluation.
Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2015
Background There is an important increase in the use of whole body computed tomography (WBCT) around the world although its benefits are still controversial. We hypothesized that the use of a WBCT protocol in the major trauma patients based on mechanism of injury alone would reduce the number of injuries that would have been missed if CT was only done based on clinical findings. Study design A prospective observational study with the inclusion of 144 patients with major blunt trauma during 5 months at our academic center. Data were collected from all patients including: epidemiology, clinical status on scene and at the emergency department, time of the scan (including patient handling), clinical findings during initial assessment and WBCT scan findings, dividing exams in with or without findings (normal). Looking for findings that would go unnoticed if CT was done based on clinical findings. Glasgow coma scale (GCS) 15 and GCS <15 were compared and data are presented as absolute ...
Abdominal computed tomography in blunt trauma
Seminars in Roentgenology, 1992
S INCE THE EARLY 1980s computed tomography (CT) has come to play a greater role in the initial evaluation of patients sustaining blunt or penetrating trauma. CT has largely replaced abdominal radiography, nuclear scintigraphy, intravenous pyelography (IVP), and sonography in the acute evaluation of the abdomen. Numerous publications have addressed the relative strengths and weaknesses of CT scanning of the abdomen versus the more traditional diagnostic peritoneal lavage (DPL). CT is advantageous over DPL in that (1) CT can assess the retroperitoneum, (2) CT decreases the rate of nontherapeutic laparotomies, which varies from 6% to 25%, that are performed based on a positive DPL result,1-3 (3) CT is more specific regarding the precise site and extent of injury, (4) CT can identify retroperitoneal or pelvic sources of hemorrhage that may create a false-positive DPL, (5) CT is noninvasive, (6) CT can detect intraparenchymal injury or subcapsular hemorrhage that may be missed by DPL, and CT can be used serially to assess resolution or progression of injuries including those managed either expectantly or surgically.