Studying The Role Of Computed Tomography In Selective Management Of Blunt Abdominal Trauma Patients In A Single Tertiary Care Centre In Northern India

摘要

Background: Trauma is the leading cause of death in persons under 45 years of age with nearly 10% of these fatalities attributable to abdominal injuries. Our study was entailed to evaluate the usefulness of computed tomography in detection of intra-abdominal injury in stable patients with blunt abdominal trauma and to provide information that could accurately determine the choice of management (operative versus non-operative), thereby reducing negative laparotomy rates.Materials and methods: Over a period of two years from June 2010 to July 2012 this prospective study included 100 patients of all ages and sex with blunt abdominal trauma who were hemodynamically stable. All patients handled conservatively were followed throughout their stay in hospital, and, when required, underwent a follow-up CT scan. The imaging diagnosis was compared with the necessity of laparotomy.Results: The mean age of patients was 28.35 years (range 4-70). Males were found more vulnerable to abdominal trauma (72%) with a male-to-female ratio of 2.6:1. The most common cause of abdominal injury was road traffic accident (59%) followed by fall from height (26%). Out of 100 patients, 83 patients had an intra-abdominal injury. Fifty six patients out of these 83 were managed non-operatively and 27 patients were operated (including one with negative laparotomy). The spleen was the most common solid organ injured (39.7%). Out of 33 injured splenic patients, 19 were managed non-operatively and 14 were operated. The liver was the second most common organ injured (27.7 %). Out of 100 patients, 17 had normal CECT scan and their stay in hospital for observation was uneventful. Fifty-six patients (majority) were managed conservatively after CECT had picked up an injury and only 27 were operated.Conclusion: Computed tomography can gauge the extent of internal injury, grade it and this information can be used to select patients and manage them non-operatively, thus reducing non-therapeutic laparotomies to a great extent. INTRODUCTION Trauma is the leading cause of death in persons under 45 years of age with 10% of these fatalities attributable to abdominal injuries [1]. Indian statistics reveal a disproportionate involvement of the younger age group (15-25) [1]. The incidence is on rise for the last decade because of an increase in working population, number of vehicles on roads and rapid industrialization.The Indian fatality rates for trauma are 20 times higher as compared to developed countries [2]. About 30% of such deaths are preventable [1]. Two important advances in past decade have been the development of emergency medical services and widespread use of CT to examine trauma patients [3,4].In hemodynamically stable patients the diagnostic modality of choice is CT scan [5]. It is non-invasive, easy to perform and has been shown as highly sensitive, specific and accurate. The use of CT has helped to decrease the total number of negative non-therapeutic laparotomies performed [6]. The isolated finding of free fluid in CT does not warrant laparotomy if no solid organ injury is present [7].CT is the modality of choice in the hemodynamically stable patients with non-penetrating trauma for evaluation of intra-abdominal injury or hematuria [7]. The current study was performed in SMHS Hospital, a tertiary care hospital of northern India, over a period of two years from June 2010 to July 2012, on 100 hemodynamically stable patients with suspicion of grievous intra-abdominal injury, who presented to the emergency department .The objective of this prospective clinical study was to evaluate the usefulness of computed tomography in detection of intra-abdominal injury in stable patients with blunt abdominal trauma so as to determine the choice of management (operative versus non-operative), thereby reducing negative laparotomy rates. PATIENTS AND METHODS The study group included patients of all ages and sex with blunt abdominal trauma who were hemodynamically stable. Indicati