Paper| Volume 28, ISSUE 3, P181-185, April 1997

Download started.


Computed tomography and blunt abdominal injury: patient selection based on examination, haematocrit and haematuria

  • J.R. Richards
    Requests for reprints should be addressed to: John R. Richards md, Division of Emergency Medicine, 2315 Stockton Boulevard, Sacramento, CA 95817, USA.
    Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USA
    Search for articles by this author
  • R.W. Derlet
    Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harlan LC
        • Harlan WR
        • Parsons PE
        The economic impact of injuries: a major source of medical costs.
        Am J Public Health. 1990; 80: 453
        • Peitzman AB
        • Makaroun MS
        • Slasky BS
        • et al.
        Prospective study of computed tomography in initial management of blunt abdominal trauma.
        J Trauma. 1986; 26: 585
        • Rodriguez A
        • DuPriest RW
        • Shatney CH
        Recognition of intra-abdominal injury in blunt trauma victims.
        Am Surg. 1982; 48: 456
        • Mackersie RC
        • Tiwary AD
        • Shackford SR
        • Hoyt DB
        Intra-abdominal injury following blunt trauma.
        Arch Surg. 1989; 124: 809
        • Hennes HM
        • Smith DS
        • Schneider K
        • et al.
        Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury.
        Pediatrics. 1990; 86: 87
        • Sahdev P
        • Garramone RR
        • Schwartz RJ
        • et al.
        Evaluation of liver function tests in screening for intra-abdominal injuries.
        Ann Emerg Med. 1991; 20: 838
        • Isaacman DJ
        • Scarfone RJ
        • Kost SI
        • et al.
        Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient.
        Pediatrics. 1993; 92: 691
        • Freshman SP
        • Wisner DW
        • Battistella FB
        • Weber CJ
        Secondary survey following blunt trauma: a new role for abdominal CT scan.
        J Trauma. 1993; 34: 337
        • Colucciello SA
        Blunt abdominal trauma.
        Emerg Med Clin North Am. 1993; 11: 107
        • Taylor GA
        • Eichelberger MR
        • Potter BM
        Hematuria. A marker of abdominal injury in children after blunt trauma.
        Ann Surg. 1988; 208: 688
        • Knudson MM
        • McAninch JW
        • Gomez R
        • et al.
        Hematuria as a predictor of abdominal injury after blunt trauma.
        Am J Surg. 1992; 164: 482
        • Baron BJ
        • Scalea TM
        • Scalfani SJ
        • et al.
        Nonoperative management of blunt abdominal trauma: the role of sequential diagnostic peritoneal lavage, computed tomography, and angiography.
        Ann Emerg Med. 1993; 22: 1556
        • Goldstein AS
        • Scalfani SJ
        • Kupferstein NH
        • et al.
        The diagnostic superiority of computerized tomography.
        J Trauma. 1985; 25: 938
        • Davis JW
        • Hoyt DB
        • Mackersie RC
        • et al.
        Complications in evaluating abdominal trauma: diagnostic peritoneal lavage versus computerized axial tomography.
        J Trauma. 1990; 30: 1506
        • Perez FG
        • O'Malley KF
        • Ross SE
        Evaluation of the abdomen in intoxicated patients: is computed tomography scan or peritoneal lavage always indicated?.
        Ann Emerg Med. 1991; 20: 500
        • Wing VW
        • Federle MP
        • Morris JA
        • et al.
        The clinical impact of CT for blunt abdominal trauma.
        Am J Radiol. 1985; 145: 1191
        • Wolfman NT
        • Bechtold RE
        • Scharling ES
        • Meredith JW
        Blunt upper abdominal trauma: evaluation by CT.
        Am J Radiol. 1992; 158: 493
        • Pevec WC
        • Peitzman AB
        • Udekwu AO
        • et al.
        Computed tomography in the evaluation of blunt abdominal trauma.
        Surg Gynecol Obstet. 1991; 173: 262
        • Matsubara TK
        • Fong HMT
        • Burns CM
        Computed tomography of abdomen in management of blunt abdominal trauma.
        J Trauma. 1990; 30: 410
        • Federle MP
        • Crass RA
        • Jeffrey RB
        • Trunkey DD
        Computed tomography in blunt abdominal trauma.
        Arch Surg. 1982; 117: 645
        • Fried AM
        • Humphries R
        • Schofield CN
        Abdominal CT scans in patients with blunt trauma: low yield in the absence of clinical findings.
        J Comput Assist Tomogr. 1992; 16: 717
        • Civil ND
        • Schwab CW
        The abbreviated injury scale, 1985 revision: a condensed chart for clinical use.
        J Trauma. 1988; 28: 87
        • Taylor GA
        • Eichelberger MR
        • O'Donnell R
        • Bowman L
        Indications for computed tomography in children with blunt abdominal trauma.
        Ann Surg. 1991; 213: 212
        • Black WC
        • Welch HG
        Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy.
        N Engl J Med. 1993; 328: 1237
        • Lang EK
        Intra-abdominal and retroperitoneal organ injuries diagnosed on dynamic computed tomograms obtained for assessment of renal trauma.
        J Trauma. 1990; 30: 1161
        • Nghiem HV
        • Jeffrey RB
        • Mindelzun RE
        CT of blunt trauma to the bowel and mesentery.
        Am J Radiol. 1993; 160: 53
        • Rizzo MJ
        • Federle MP
        • Griffiths BG
        Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT.
        Radiology. 1989; 173: 143
        • Mirvis SE
        • Gens DR
        • Shanmuganathan K
        Rupture of the bowel after blunt abdominal trauma: diagnosis with CT.
        Am J Radiol. 1992; 159: 1217
        • Kunin JR
        • Korobkin M
        • Ellis JH
        • et al.
        Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma.
        Am J Radiol. 1993; 160: 1221
        • Kohn JS
        • Clark DE
        • Isler RJ
        • Pope CF
        Is computed tomographic grading of splenic injury useful in the nonsurgical management of blunt trauma?.
        J Trauma. 1994; 36: 385
        • Buntain WL
        • Gould HR
        • Maull KI
        Predictability of splenic salvage by computed tomography.
        J Trauma. 1988; 28: 24
        • Meyer AA
        • Crass RA
        • Lim RC
        • et al.
        Selective nonoperative management of blunt liver injury using computed tomography.
        Arch Surg. 1985; 120: 550