The general rule for penetrating trauma, especially gunshots to the abdomen, is that you don’t need to obtain a CT scan to help you decide to go to the OR. (Of course, there are a few exceptions.) And the corollary has always been that you don’t need to get a CT scan after you operate for penetrating trauma.
But the group at UCSF is questioning this. They retrospectively looked at 5 years of data on patients who underwent trauma laparotomy without preoperative imaging. They focused on new findings on CT that were not reported during the initial operation.
Here are the factoids:
- 230 of 328 patients undergoing a trauma lap did not have preop imaging
- 85 of the 230 patients (37%) underwent immediate postop CT scan. These patients tended to have a gunshot mechanism and higher injury severity score.
- Unreported injuries were found in 45% (!) and tended to be GU and orthopedic in nature
- 47% of those with unreported injuries found required some sort of intervention
Bottom line: This is a very interesting and potentially practice changing study. However, there is some opportunity for bias since only select patients underwent postop scanning. Nevertheless, one in five patients who did get a postop scan had an injury that required some sort of intervention. This study begs to be reworked to further support it, and to develop specific criteria for postop scanning.
Questions/comments for the authors/presenters:
- Be sure to break down your results by gunshot vs stab. This will help formulate those criteria I mentioned above.
- Specifically list the occult injuries and interventions required. In some studies, those “required interventions” are pretty weak (urology consult vs an actual procedure).
- How exactly did the operating surgeons determine who to send to CT? Was it surgeon-specific (i.e. one surgeon always did, another never did)? Was it due to operative findings (hole near the kidney)? This is also needed when developing specific criteria for postop imaging.
- Nice poster!
- Tips for managing penetrating injuries
- Can I take a hypotensive patient to CT?
- Penetrating wounds: to probe or not to probe?
Reference: Routine tomography after recent operative exploration for penetrating trauma: what injuries do we miss? Poster #14, EAST 2017.