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Abstract
The criteria for ordering abdominal CT scans in the secondary survey of stable bluntly
injured patients was examined. A patient population at high risk for having intra-abdominal
injury (IAI) was identified by physical examination, a fall in haematocrit, and haematuria.
A total of 444 patients receiving abdominal CT scans at a large urban trauma centre
were reviewed. IAI was diagnosed in 49 (11 per cent), by radiographic and/or intra-operative
findings. Abdominal tenderness was present in all 17 patients who underwent surgery.
The sensitivity and specificity of abdominal CT scanning was 90 per cent and 99 per
cent, respectively. The abdominal exam had a sensitivity of 63 per cent and a specificity
of 65 per cent. A fall in haematocrit ≥5 was not statistically significant. The combined
abdominal exam and haematuria yielded a specificity of 93 per cent with a negative
predictive value (NPV) of 93 per cent. Early CT scanning of stable patients who had
sustained blunt injuries is an effective screen for IAI. The benefit of a CT scan
for patients without abdominal tenderness or with an isolated fall in haematocrit
is questionable. Serial abdominal examinations should remain the most timely and cost-effective
method for identifying IAI in stable patients. The specificity and NPV of abdominal
tenderness combined with haematuria approaches that of CT.
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Article info
Publication history
Accepted:
November 14,
1996
Identification
Copyright
© 1997 Published by Elsevier Inc.
