Computerized Axial Tomography in patients with severe abdominal trauma: is it a justifiable risk?

摘要

Objective: to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. Methods: retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. Results: considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. Conclusion: CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.