Use Of Computed Tomography Research Articles

CT Features of Vasculitides Based on the 2012 International Chapel Hill Consensus Conference Revised Classification.

Vasculitis, characterized by inflammation of vessel walls, is comprised of heterogeneous clinicopathological entities, and thus poses a diagnostic challenge. The most widely used approach for classifying vasculitides is based on the International Chapel Hill Consensus Conference (CHCC) nomenclature system. Based on the recently revised CHCC 2012, we propose computed tomography (CT) features of vasculitides and a differential diagnosis based on location and morphological characteristics. Finally, vasculitis mimics should be differentiated, because erroneous application of immunosuppressive drugs on vasculitis mimics may be ineffective, even deteriorating. This article presents the utility of CT in the diagnosis and differential diagnosis of vasculitides.

Improving ultrasound for appendicitis through standardized reporting of secondary signs

ObjectiveOur aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation. MethodsA multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pretemplate and posttemplate. ResultsWe identified 387 patients in the pretemplate period and 483 patients in the posttemplate period. In the posttemplate period, the reporting of SS increased from 5.4% to 79.5% (p<0.001). Despite lower rates of appendix visualization (43.9% to 32.7%, p<0.001) with US, overall CT use (8.5% vs 7.0%, p=0.41) and the negative appendectomy rate remained stable (1.0% vs 1.0%, p=1.0). CT utilization for patients with an equivocal ultrasound and SS present decreased (36.4% vs 8.9%, p=0.002) and admissions for observations decreased (21.5% vs 15.3%, p=0.02). Test characteristics of RLQ US for appendicitis also improved in the posttemplate period. ConclusionA focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation.Study of a Diagnostic Test Level of Evidence: 1.

Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases with a Diagnostic Algorithm: Shah SR, Sinclair KA, Theut SB, et al. Ann Surg. 2016;264:474-481

Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases with a Diagnostic Algorithm: Shah SR, Sinclair KA, Theut SB, et al. Ann Surg. 2016;264:474-481

Prevalence of negative CT scans in a level one trauma center.

The rise of computed tomography (CT) use in trauma has become the subject of concern given the harms of CT including radiation, cost, over diagnosis and identification of incidental lesions. We developed a novel metric, the Negative CT Score, (∑CT-) which quantifies how often CT imaging identifies important injuries. Our objective was to describe the pattern of CT utilization in trauma at an urban academic level one trauma center using this novel metric. This was a retrospective study of intermediate level trauma patients who received CT imaging over a 1-year study period at an urban level one trauma center. We applied the Negative CT Score, (∑CT-) to quantify the results of CT imaging. ∑CT- is computed by subtracting the number of non-extremity body regions (maximum four: head, neck, chest, abdomen) with an important positive CT finding (defined by a priori criteria) from the total number of non-extremity body regions scanned. Of the 552 cases reviewed during the study period, 410 (74.3%) were male and the mean age was 40.3years [SD±21.2]. Four hundred eighty-six patients (88.0%) suffered blunt trauma; 66 (12.0%) suffered penetrating trauma. The average injury severity score for admitted patients was seven. Four hundred ninety-five cases had at least one CT performed. The average number of regions per patient that received CT imaging was 2.36 (SD±1.3), and the average ∑CT- was 2.10 (SD±1.2). Three hundred and sixty-seven (74.3%) patients had no important findings on CT imaging. In a consecutive series of 552 intermediate trauma patients at our urban trauma center, 2.36 body regions were scanned per patient; of these, 2.10 regions revealed no important CT findings. We hope that these results and the Negative CT Score can be used to identify trends, variations in practice, and outliers within and across departments so that CT utilization can be optimized.

Diagnostic evaluation of ovarian torsion: An analysis of pediatric patients using the Nationwide Emergency Department Sample

BackgroundUltrasonography (US) is the diagnostic modality of choice during work-up for ovarian torsion, although computed tomography (CT) may be used. We examined the utilization of CT in girls with ovarian torsion, and determined which patients are most likely to undergo this study. MethodsThe Nationwide Emergency Department Sample dataset was searched for patients <18 years who presented with ovarian torsion from 2006 to 2012. Hospitals were categorized by the volume of pediatric patients seen. ResultsA total of 1279 patients were identified. Seven hundred twelve (56%) were seen at adult hospitals, 154 (12%) at pediatric privileged, and 413 (32%) at pediatric hospitals. Patients cared for in a pediatric or pediatric privileged hospital had more US alone performed to diagnose ovarian torsion (p < 0.01). ConclusionsGirls seen at pediatric hospitals are more likely to undergo US for work-up of ovarian torsion.

Clinical application of multidetector computed tomography and magnetic resonance imaging for evaluation of cranial nerves in horses in comparison with high resolution imaging standards

SummaryAlthough horses are affected by cranial nerve disease, our understanding of these structures' imaging anatomy is limited, and the optimal modality for imaging of each of these nerves is unclear. The aim of this study was to describe the imaging appearance of the equine cranial nerves on high‐resolution 1.5T magnetic resonance imaging (MRI) and computed tomography (CT) scans of a cadaver head, and with these as standards, examine the utility of MRI and CT performed in clinical cases. High‐resolution MRI and CT images were prospectively acquired of the head of a normal Thoroughbred gelding following euthanasia. Ten clinical cases undergoing high‐field MRI under general anaesthesia and 10 clinical cases undergoing CT in the standing horse under sedation were retrospectively evaluated by three reviewers to assess cranial nerve visibility. On high‐resolution, thin‐slice, MRI scans of the normal cadaver head, each of the 12 cranial nerves and their topographic location could be appreciated. On high‐resolution cadaver CT, cranial nerves II, V and VII were clearly visible, but others were less easily identified; osseous structures were clearly visualised. Clinical MRI and CT allowed for variable visualisation of the cranial nerves, dependent on the sequence and the orientation of scan planes. High‐field MRI allowed excellent visualisation of equine cranial nerves, whereas CT allowed for more detailed visualisation of the osseous canals and foramina. In live horses, the ability to identify all 12 nerves is challenging with either MRI or CT; however, high‐field MRI enables better visualisation of the nerve bundles than CT.

Scanning the Confusion Away: The Diagnostic Utility of Head Computer Tomography (CT) in the Evaluation of Altered Mental Status in a Non-Neurological Medical ICU of a Tertiary Care Center

Scanning the Confusion Away: The Diagnostic Utility of Head Computer Tomography (CT) in the Evaluation of Altered Mental Status in a Non-Neurological Medical ICU of a Tertiary Care Center

174 The Feasibility of Consent for Computed Tomography in Acute Trauma Patients

Although the prevalence of injury has remained constant, computed tomography (CT) use in trauma evaluation has increased dramatically in the past two decades, increasing costs and exposing patients to potentially cancer-causing radiation. Despite these potential harms, expense, and other research demonstrating that trauma patients wish to be informed of the risks and costs of CT, consent for trauma CT is not routinely obtained in adults. The reasons for not obtaining consent may include concerns about lack of time and patients having altered mental status that would preclude adequate consent. In this prospective study we sought to determine whether obtaining consent for CT is feasible from these standpoints in adult trauma patients. We conducted this two-phase, prospective study at two urban Level 1 trauma centers. In the first phase we determined the median time needed to obtain consent for CT by performing sham consent on 11 trauma patients at each site. In the second phase we observed adult trauma activation cases, recording patients’ Glasgow Coma Scores (GCS) and time available for consent for CT (TACCT)—defined as the time (rounded to the nearest minute) between the end of the physician’s secondary survey and when the patient left the trauma resuscitation room to go to CT. Trauma providers were unaware of the study and these observations. We defined, a priori, feasible consent cases as those in which the patient had a GCS of 15 and a TACCT > than the median time for consent at that site. The median times for sham CT consent in phase 1 were 2 and 4 minutes. Of the 729 patients enrolled in phase 2, 647 (89%) underwent CT evaluation. Their median age was 52 years (IQR 32, 74); 54% were male; 95% had a blunt mechanism of trauma; 55% were admitted to the hospital; and 5% had a surgical procedure performed after CT. The median and mean TACCT were 11 min (IQR 7, 19) and 17 min (SD 20) respectively. The median GCS was 15 (IQR 14, 15). Of the 647 patients enrolled, 439 patients (67.9%; 95% confidence interval [CI] 64.2 – 71.3%) met feasible consent criteria. Of the 208 patients who did not meet feasible consent criteria, 190 (91.4%; 95% CI 86.7 – 94.5%) had a GCS less than 15 and 18 (8.7%; 95% CI 5.5 – 13.3%) had a short TACCT. In this study of acute, adult trauma patients, consent for CT was feasible in over two-thirds of patients. When CT was not feasible, the primary reason was a GCS < 15. When considering efforts to increase shared decision-making between medical providers and acute trauma patients, informed consent for CT scans is a feasible option. Future studies may determine if providing such informed consent correlates with improvement in patient satisfaction and more efficient CT utilization.

87 Reducing Computed Tomography Utilization in the Evaluation of Renal Colic in the Emergency Department

87 Reducing Computed Tomography Utilization in the Evaluation of Renal Colic in the Emergency Department

Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases With a Diagnostic Algorithm

The primary objective of this project was to decrease computed tomography (CT) utilization for the diagnosis of appendicitis in an academic children's hospital emergency department (ED) through a multidisciplinary quality improvement initiative. Appendicitis is the most common abdominal diagnosis leading to the hospitalization of children in the United States. However, the diagnosis of appendicitis in children can be difficult and many centers rely heavily upon CT scans. Recent recommendations emphasize decreasing CT use among pediatric patients because of an increased lifetime risk of radiation-induced malignancies. A retrospective review was conducted of patients diagnosed with appendicitis in the ED at Children's Mercy Hospital from January 1, 2011 to February 28, 2014 to establish a baseline cohort. From August 1, 2014 to July 31, 2015, a newly designed diagnostic algorithm was used in the ED and patients were prospectively followed. Any patient discharged from the ED received a follow-up phone call. Patients treated for appendicitis before and after pathway implementation were compared. In addition, any patient evaluated for appendicitis after implementation of the algorithm was analyzed for adherence to the clinical pathway. Differences between the 2 groups were analyzed using ANOVA, Wilcoxon Rank Sum, χ, and Fisher Exact tests. Of 840 patients seen after implementation of the diagnostic algorithm, 267 were diagnosed with appendicitis. After implementation of the algorithm, CT utilization decreased from 75.4% to 24.2% (P < 0.0001) in patients with appendicitis. CT utilization was 27.3% after implementation, regardless of the ultimate diagnosis or algorithm adherence. The diagnostic pathway had a sensitivity of 98.6% and specificity of 94.4%. Implementation of a diagnostic algorithm for appendicitis in children significantly decreases CT utilization, whereas maintaining a high sensitivity and specificity.

Utility of dual-energy spectral CT and low-iodine contrast medium in DIEP angiography.

To evaluate the utility of dual-energy spectral computed tomography (CT) and low-iodine intake in CT angiography (CTA) of deep inferior epigastric perforator (DIEP) flaps. In this prospective study, 40 patients with a BMI <28.0kg/m(2) underwent CTA examination for breast reconstruction and were randomly assigned into two groups (n=20 for each group) as follows: Group A was submitted to dual-energy spectral CT and iodixanol (270mgI/mL) and Group B was submitted to conventional high iodine contrast agent iohexol (350mgI/mL). The volume CT dose index (CTDIvol ) and dose length product were recorded and the effective dose (ED) was calculated. The best mono-spectrum images of Group A were selected according to the optimal contrast to noise ratio (CNR). Both mono-spectrum images of Group A and polychromatic images of Group B were used to reconstruct maximum intensity projection (MIP) and volume rendering (VR) images of the perforating artery, respectively. Two radiologists evaluated subjective image quality using a 4-point score. The diameter of the perforating artery, CT value and SD value for the common femoral artery were measured and the CNR was calculated. The total iodine intake and radiation doses of the two groups were calculated and compared. The best mono-spectrum energy with the optimal CNR of the perforating artery was 63keV. The CT value of common femoral artery in Group A (380.96±42.75HU) was 7.40% higher than in Group B (354.71±42.01 HU) but with no statistical significance (P>.05). The CNR of the common femoral artery in Group A (23.84±6.73) was 6.88% lower than in Group B (25.60±6.20), with no significant difference (P>.05). The diameters of the perforator vessels were 2.44±0.15 and 2.49±0.14mm, respectively, with no significant difference (P>.05). Subjective image qualities for the two groups were both good for diagnostics, and the scores for Group A and Group B were (3.88±0.28) and (3.93±0.18), respectively. The scores of the two radiologists were consistent (kappa=0.634). The effective radiation dose in Group A (9.09±0mSv) was 10.62% lower than in Group B (10.17±1.91mSv). The total iodine intake in Group A (27000mg) was 22.86% lower than in Group B (35000mg). The combination of dual-energy spectral CT and low-iodine intake in CTA of DIEP flap examination with the optimal CNR technology can meet the requirements of clinical diagnostics, with a 22.86% reduction in total iodine intake and an 11.01% reduction in radiation dose.

Truth or dare: Achieving lower radiation doses in CT

The continuous evolution of computed tomography (CT) technology has allowed for wider clinical CT utilization. However the increased radiation doses associated with CT have raised concerns about the risk of carcinogenesis among Radiation Protection Authorities, health professionals and patients. Although the benefit of a justified CT examination by and large outweighs the risk, optimization of the procedure is essential to further this risk. Moreover CT manufacturers have developed several dose reduction tools and dose alert platforms to modulate and record the radiation doses administered to patients. The scope of this presentation is to outline the significance of optimization in CT, to describe CT parameters, scanner dose output indices and the methodology to reduce dose without compromising diagnostic quality. Learning Outcomes: Following the presentation, participants will be able to: 1. Demonstrate the difference between CT scanner output and effective dose. 2. Fine-tune dose reduction parameters ensuring ALARA and according to clinical requirements (i.e. mAs and kV modulation, section collimation, detector array selection, pitch). 3. Distinguish between noise reduction iterative reconstruction algorithms and dose. 4. Correlate CT dose indices to national DRLs. 5. Participate in CT protocol design and continuous quality improvement programs. 6. Promote Radiation Protection Campaigns (i.e. Image Wisely, Image Gently, Eurosafe Imaging, RPOP). No disclosures.

The role of computed tomography after emergent trauma operation

BackgroundAlthough computed tomography (CT) has become the preferred diagnostic modality, immediate surgical intervention is often required for severely injured patients with minimum preoperative radiographic evaluation. The utility of postoperative CT (postop-CT) for the identification of undiagnosed injuries and its impact on patient management remain unclear. The purpose of this study was to evaluate the utility of postop-CT for the identification of clinically significant injuries in patients who underwent an emergent life-saving procedure. MethodsA 5-y retrospective study from 2009 to 2013 was conducted at a high-volume level I trauma center. We included blunt and penetrating trauma patients who underwent an emergent operation (neck exploration, thoracotomy, and laparotomy) without preoperative CT. Postop-CT was obtained within 48 h after the initial operation at the discretion of the attending trauma surgeon. Characteristics of newly diagnosed injuries on postop-CT were analyzed. These injuries were considered clinically significant when the patient required (1) immediate intervention; (2) new consultation from a specialty service; or (3) a higher level of care. ResultsA total of 89 patients met our inclusion criteria (five neck explorations, 16 thoracotomies, and 74 laparotomies) with the following characteristics: median age of 30 y, 87.6% male, 47.2% penetrating injury, and median injury severity score of 24. New injuries were identified on postop-CT in 59 cases (66%), and clinical management was changed in 51 cases (57%). Patients with an admission Glasgow Coma Scale <15 and solid organ injury identified during the index operation were more likely to have new injuries on postop-CT. ConclusionsIn patients undergoing an emergent operation before having their full diagnostic workup completed, postop-CT often demonstrates clinically significant injuries. Further prospective study to identify the patients who will benefit from postop-CT is warranted.

The Association Between Physician Empathy and Variation in Imaging Use.

Variation in emergency physician computed tomography (CT) imaging utilization is well described, but little is known about what drives it. Physician empathy has been proposed as a potential characteristic affecting CT utilization. The objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. We also sought to compare emergency physician performance on an empathy psychometric test with performance on other psychometric tests previously proposed as predictors of CT utilization. This cross-sectional study included two parts: 1) a secondary analysis of emergency department (ED) CT imaging utilization data in a large health system from July 2013 to June 2014 and 2) a survey study of the cohort of physicians responsible for this imaging using four psychometric scales: the Jefferson Scale of Empathy (JSE), a risk-taking subset of the Jackson Personality Index (RTS), the Stress from Uncertainty Scale (SUS), and the Malpractice Fear Scale (MFS). The study included data and physicians from four EDs: one urban, academic ED, two community, and one free-standing. A hierarchical, mixed-effects regression model was used to evaluate the association between emergency physician performance on the four scales and risk-adjusted CT imaging utilization. The model incorporated physician-specific CT utilization rates adjusted for propensity scores that were calculated using over 500 patient-level variables via random forest methods, physician demographics, and a random provider effect to account for the clustering of observations. CT variation analysis included 113,517 patients seen during the study period by the 74 eligible emergency physician survey respondents; 20,972 (18.5%) of these patients had at least one CT. The survey response rate was 74 of 82 (90.2%). Correlation coefficients between JSE and the other scales were not statistically significant. In subset analysis, there was a trend toward a physician's number of years in practice and RTS score contributing to CT utilization for traumatic head CT. There were no significant associations between performance on any of the psychometric scales and CT utilization. Performance on the JSE, RTS, SUS, or MFS was not predictive of risk-adjusted CT utilization in the ED. The underlying physician-based factors that mediate interphysician variation remain to be clearly identified.

Impact of Intraoperative Cone Beam Computed Tomography on Reduction Quality and Implant Position in Treatment of Tibial Plafond Fractures.

The intraoperative assessment of the articular surface in displaced intra-articular distal tibia fractures can be challenging using conventional fluoroscopy. The aim of the study was to determine the frequency and the method of intraoperative corrections of fracture reductions or implant placements during open reduction, internal fixation by using cone beam computed tomography (CT) after conventional fluoroscopy. Displaced intra-articular distal tibia fractures were retrospectively analyzed from August 2001 until December 2011. The fractures were classified according to the standards of the AO/OTA as type B or C and treated with open reduction and internal plate fixation. After primary reduction using conventional fluoroscopy, an additional cone beam CT scan was used to determine the alignment of the joint line and the implant position. The number of intraoperative revisions of the primary reduction due to the use of cone beam CT was analyzed. A total of 143 patients with an intra-articular tibial plafond fracture were included in the analysis. In 43 patients (30%), an intraoperative correction was performed after the cone beam CT scan. In 34 (24%) of these cases, intraoperative correction was required because of inadequate joint line reduction. Nine (6%) corrections were required as a result of a malposition of the implant. The revision rate did not differ by fracture classification. Despite its acceptance as the standard method of imaging, intraoperative conventional fluoroscopy for the assessment of implant positioning and fracture reduction of tibial plafond fractures is limited. The intraoperative utilization of cone beam CT provided additional information for the surgeon to detect insufficient reduction or implant malposition. Level III, retrospective comparative series.

Ultra low dose CT screen-detected non-malignant incidental findings in the Western Australian Asbestos Review Programme.

Computed tomography (CT)-based studies of asbestos-exposed individuals report a high prevalence of lung cancer, but the utility of low dose CT (LDCT) to screen asbestos-exposed populations is not established. We aimed to describe the prevalence of indeterminate pulmonary nodules and incidental findings on chest LDCT of asbestos-exposed subjects in Western Australia. A total of 906 subjects from the Western Australian Asbestos Review Programme underwent LDCT of the chest as part of regular annual review. An indeterminate (solid) nodule was defined as >50 mm3 and part-solid/non-solid nodules >5 mm. The presence of asbestos-related diseases was recorded with a standardized report. Subjects were mostly (81%) men with a median age of 70 years. Fifty-eight (6.5%) participants were current smokers, 511 (56.4%) ex-smokers and 325 (36.4%) never-smokers. One hundred and four indeterminate nodules were detected in 77 subjects (8.5%); of these, eight cases had confirmed lung cancer (0.88%). Eighty-seven subjects (9.6%) had incidental findings that required further investigation, 42 (4.6%) from lower airways inflammation. The majority of nodules were solid, 4-6 mm and more common with age. Five hundred and eighty (64%) subjects had pleural plaques, and 364 (40.2%) had evidence of interstitial lung disease. The prevalence of LDCT-detected indeterminate lung nodules in 906 individuals with significant asbestos exposure was 8.5%, lower than many other CT studies. Clinically important incidental findings were found in 9.4%, predominantly related to lower respiratory tract inflammation. LDCT appears to effectively describe asbestos-related diseases and is likely to be an acceptable modality to monitor asbestos-exposed individuals.

Su1788 Computed Tomography Utilization Abruptly Increases at Age 18 among Patients with Inflammatory Bowel Diseases, A Nationwide Analysis of the Insured

Su1788 Computed Tomography Utilization Abruptly Increases at Age 18 among Patients with Inflammatory Bowel Diseases, A Nationwide Analysis of the Insured

Utility of additional abdominopelvic CT in detecting occult cancer in patients with unprovoked venous thromboembolism

To analyse the positive rate for cancer on additional abdominopelvic computed tomography (CT) in patients with unprovoked venous thromboembolism (VTE), evaluate the subsequent emergence of a cancer diagnosis in the clinical follow-up period, and identify any possible predictive factors of cancer in this cohort, which may allow better selection of patients for additional imaging. Consecutive adult patients with VTE were retrospectively identified in two large teaching hospitals between January 2013 and June 2014, including a subset of those with unprovoked VTE. Relevant demographic data were extracted and analysed. All patients had a minimum of 12 months clinicoradiological follow-up. One thousand four hundred and forty-six patients with VTE were deemed eligible, of which 699 (48%) were male; the median age (range) was 66 (16-102) years. The prevalence of pre-existing cancer in these patients was 343/1446 (24%), and 388/1446 (27%) were classified as unprovoked VTE. In 12/1446 (0.8%), cancer was diagnosed synchronously with VTE on the initial imaging investigation. Additional screening imaging was performed in 232/388 (60%) including abdominopelvic CT in 205 (53%) patients with unprovoked VTE. Only five additional cancers were identified, all of these occurring in patients with clinical symptoms suspicious for cancer. None of the additional CT examinations identified any clinically occult cancer in asymptomatic patients, and subsequent mean follow-up of 22 (SD=6) months also failed to reveal any further cancer diagnosis. Contrary to the National Institute of Health and Care Excellence (NICE) guidance, the yield of performing additional abdominopelvic CT as a screening tool for occult cancer in asymptomatic patients with unprovoked VTE is negligible. A more selective and clinically-driven assessment of these patients is recommended.

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan.

Steady increase in computed tomography (CT) utilisation in the ED was observed in countries such as the USA, Canada, China and Korea; however, limited empirical data are available regarding Taiwan. The objective of the present study is to quantify and compare trends in CT utilisation in the ED over a 5 year period in a medical centre in Taiwan. Electronic chart review was performed in a medical centre with an annual ED census of 80 000 patients. Subjects >20 years of age who underwent CT scans during ED visits from 1 January 2005 to 31 December 2009 were identified. Among the 333 673 adult ED visits, 43 635 received CT scans, with a utilisation rate of 131 per 1000. Within the 5 year span, patient volume increased by 7.7%, whereas CT utilisation increased by 42.7%. The rates of increase in patient volume and CT utilisation were 5.0% and 32.4% in non-trauma; 19.7% and 97.8% in trauma. CT scans were mostly performed on the head (47%), abdomen (36%), followed by chest (10%) and miscellaneous (7%). An increase of 168% in spinal CTs for trauma patients was observed. An increase in CT utilisation was found in all age groups with a proportionate increase with increasing age in both trauma and non-trauma. ED CT utilisation has increased at a rate far exceeding the growth in ED patient volume. This may be attributed to the improved utility of CT in diagnosing serious pathology, more diagnostic indications for CT, ready availability and the necessity for diagnostic certainty in the ED.

Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma.

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. (©) RSNA, 2016.