Does CT Accurately Predict Visceral Injury After a Stab Wound?
Does CT Accurately Predict Visceral Injury After a Stab Wound?
Salim A, Sangthong B, Martin M, et al
Arch Surg. 2006;141:745-752
Can computed tomography (CT) scans accurately predict visceral injury after an anterior abdominal stab wound (AASW)? The authors studied 156 patients at a level 1 trauma center. Patients with an obvious visceral injury at the time of presentation were excluded. Sixty-seven patients of the 156 patients had an initial CT scan, and of these, 19 CT scans were positive, which led to laparotomy in 10 patients. The treatment groups were not randomly assigned. The negative predictive value of a CT scan after AASW was 100% if 2 patients with thoracoabdominal wounds were excluded. However, the positive predictive value was only 42%. The authors felt that CT scans changed the management in 12 (18%) of the 67 patients who received initial CT scans.
As pointed out in this and many other reports, not all AASW patients require an exploratory laparotomy. The challenge is to select those patients who will need an operation. In addition to physical examination and observations, various options are available, including local wound exploration, peritoneal lavage, ultrasonography, and perhaps CT scan. Any benefit must be viewed in light of the extra cost, delay, and utility compared with other more commonly used diagnostic procedures. A carefully designed truly randomized trial will be necessary to settle this question.
Abstract
Use of Computed Tomography in Anterior Abdominal Stab Wounds: Results of a Prospective Study
Salim A, Sangthong B, Martin M, et al
Arch Surg. 2006;141:745-752
Summary
Can computed tomography (CT) scans accurately predict visceral injury after an anterior abdominal stab wound (AASW)? The authors studied 156 patients at a level 1 trauma center. Patients with an obvious visceral injury at the time of presentation were excluded. Sixty-seven patients of the 156 patients had an initial CT scan, and of these, 19 CT scans were positive, which led to laparotomy in 10 patients. The treatment groups were not randomly assigned. The negative predictive value of a CT scan after AASW was 100% if 2 patients with thoracoabdominal wounds were excluded. However, the positive predictive value was only 42%. The authors felt that CT scans changed the management in 12 (18%) of the 67 patients who received initial CT scans.
Viewpoint
As pointed out in this and many other reports, not all AASW patients require an exploratory laparotomy. The challenge is to select those patients who will need an operation. In addition to physical examination and observations, various options are available, including local wound exploration, peritoneal lavage, ultrasonography, and perhaps CT scan. Any benefit must be viewed in light of the extra cost, delay, and utility compared with other more commonly used diagnostic procedures. A carefully designed truly randomized trial will be necessary to settle this question.
Abstract