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Limitation of computed tomography in the evaluation of acute abdominal trauma: A prospective comparison with diagnostic peritoneal lavage
Abstracts
completed without further incident and the patients discharged after a brief observation period. The authors conclude that intravenous fantanyl allows quick, meticulous wound repair without hospitalization on a quiet and relaxed child. Immediate availability of resuscitation equipment and a narcotic antagonist is recommended. [James B. Nolin, MD] Editor’s Note: This appears to be a relatively safe yet effective method of sedation for pediatric patients undergoing difficult laceration repair.
0 LIMITATION OF COMPUTED TOMOGRAPHY IN THE EVALUATION OF ACUTE ABDOMINAL TRAUMA: A PROSPECTIVE COMPARISON WITH DIAGNOSTIC PERITONEAL LAVAGE. Marx JA, Moore EE, Jorden RC, et al. J Trauma 1985; 25:933-937. This prospective study of 100 acutely injured patients compares diagnostic peritoneal lavage (DPL) and computed tomography (CT) in the detection of intraperitoneal injury and hemorrhage. Stable patients with stab wounds to the lower chest, abdominal stab wounds with positive or equivocal local exploration, and blunt trauma victims with an equivocal examination, signs of hypovolemia, or altered sensorium, and those who had sustained high-deceleration injury underwent DPL via an open technique at the infraumbilical ring. After initial DPL aspiration, CT of the abdomen with enhancement was performed. DPL was completed after CT via an indwelling peritoneal catheter in those patients in whom initial aspiration had been negative. Of the 65 patients with blunt trauma, five patients were explored; all were found to have injuries requiring intervention. DPL detected all five (100%) of these injuries; CT detected two (400/o). Of the 35 patients with penetrating trauma, nine were explored; seven had injuries requiring repair. DPL detected all seven; CT detected only one. One false positive DPL and one false positive CT led to two unnecessary laparotomies. Overall, the sensitivity of DPL was 100% compared with 25% for CT. Specificity was 98.9% for both DPL and CT. In particular, CT missed seven solid visceral, five hollow visceral, three diaphragmatic, and one major vascular lesion requiring operative intervention. The authors note a high incidence of false negative CT scans and support DPL as the most accurate method
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of determining the need for exploratory laparotomy in the acutely injured patient. [Ian F. Morris, MD]
RUPTURED ABDOMINAL AORTIC AN0 EURYSM. Bodily KC, Buttorff JD. Am JSurgery 1985; 149:580-582. This study was performed to identify factors that may influence the survival of patients undergoing surgery for ruptured abdominal aortic aneurysm. Thirty-seven charts with a discharge diagnosis of ruptured abdominal aortic aneurysm obtained from five hospitals during the five-year period ending December 31, 1983, were retrospectively reviewed. Data abstracted from the charts included patient age, presence of associated disease, preoperative shock defined as a systolic blood pressure less than 90 mm Hg, delay until initiation of surgery, status of the aneurysm, length of survival, and time of death. Fourteen (38%) patients survived until discharge. Of the patients without preoperative shock, 56% survived; when preoperative shock was present, survival was 32%. The time delay from presentation to the initiation of surgery in patients with preoperative shock was 4 hours 19 minutes compared with 26 hours 34 minutes in patients without shock. Time delays of greater than 24 hours were universally attributed to misdiagnosis at the time of admission. Eighteen (49%) patients had a previously diagnosed abdominal aortic aneurysm; this knowledge did not decrease the incidence of preoperative shock or the time delay until surgery. Only 33% of patients with previously diagnosed aneurysms survived. The authors stress the need for improved community understanding of aneurysms, their natural history, and the necessity for prompt diagnosis and immediate surgical intervention. The presence of preoperative shock is common and portends a poor prognosis. [Becky Roberts, \II)]
0 A SURVEY OF ADVANCED TRAUMA LIFE SUPPORT PROCEDURES BEING PERFORMED BY PHYSICIANS AND NURSES USED ON HOSPITAL AEROMEDICAL EVACUATION SERVICES. Thomas F, Clemmer TP, Orme JF. Aviat Space Environ Med 1985; 56:1213-1215. Questionnaires were sent to 71 hospitals having rotor or fixed-wing aeromedical evacuation
completed without further incident and the patients discharged after a brief observation period. The authors conclude that intravenous fantanyl allows quick, meticulous wound repair without hospitalization on a quiet and relaxed child. Immediate availability of resuscitation equipment and a narcotic antagonist is recommended. [James B. Nolin, MD] Editor’s Note: This appears to be a relatively safe yet effective method of sedation for pediatric patients undergoing difficult laceration repair.
0 LIMITATION OF COMPUTED TOMOGRAPHY IN THE EVALUATION OF ACUTE ABDOMINAL TRAUMA: A PROSPECTIVE COMPARISON WITH DIAGNOSTIC PERITONEAL LAVAGE. Marx JA, Moore EE, Jorden RC, et al. J Trauma 1985; 25:933-937. This prospective study of 100 acutely injured patients compares diagnostic peritoneal lavage (DPL) and computed tomography (CT) in the detection of intraperitoneal injury and hemorrhage. Stable patients with stab wounds to the lower chest, abdominal stab wounds with positive or equivocal local exploration, and blunt trauma victims with an equivocal examination, signs of hypovolemia, or altered sensorium, and those who had sustained high-deceleration injury underwent DPL via an open technique at the infraumbilical ring. After initial DPL aspiration, CT of the abdomen with enhancement was performed. DPL was completed after CT via an indwelling peritoneal catheter in those patients in whom initial aspiration had been negative. Of the 65 patients with blunt trauma, five patients were explored; all were found to have injuries requiring intervention. DPL detected all five (100%) of these injuries; CT detected two (400/o). Of the 35 patients with penetrating trauma, nine were explored; seven had injuries requiring repair. DPL detected all seven; CT detected only one. One false positive DPL and one false positive CT led to two unnecessary laparotomies. Overall, the sensitivity of DPL was 100% compared with 25% for CT. Specificity was 98.9% for both DPL and CT. In particular, CT missed seven solid visceral, five hollow visceral, three diaphragmatic, and one major vascular lesion requiring operative intervention. The authors note a high incidence of false negative CT scans and support DPL as the most accurate method
179
of determining the need for exploratory laparotomy in the acutely injured patient. [Ian F. Morris, MD]
RUPTURED ABDOMINAL AORTIC AN0 EURYSM. Bodily KC, Buttorff JD. Am JSurgery 1985; 149:580-582. This study was performed to identify factors that may influence the survival of patients undergoing surgery for ruptured abdominal aortic aneurysm. Thirty-seven charts with a discharge diagnosis of ruptured abdominal aortic aneurysm obtained from five hospitals during the five-year period ending December 31, 1983, were retrospectively reviewed. Data abstracted from the charts included patient age, presence of associated disease, preoperative shock defined as a systolic blood pressure less than 90 mm Hg, delay until initiation of surgery, status of the aneurysm, length of survival, and time of death. Fourteen (38%) patients survived until discharge. Of the patients without preoperative shock, 56% survived; when preoperative shock was present, survival was 32%. The time delay from presentation to the initiation of surgery in patients with preoperative shock was 4 hours 19 minutes compared with 26 hours 34 minutes in patients without shock. Time delays of greater than 24 hours were universally attributed to misdiagnosis at the time of admission. Eighteen (49%) patients had a previously diagnosed abdominal aortic aneurysm; this knowledge did not decrease the incidence of preoperative shock or the time delay until surgery. Only 33% of patients with previously diagnosed aneurysms survived. The authors stress the need for improved community understanding of aneurysms, their natural history, and the necessity for prompt diagnosis and immediate surgical intervention. The presence of preoperative shock is common and portends a poor prognosis. [Becky Roberts, \II)]
0 A SURVEY OF ADVANCED TRAUMA LIFE SUPPORT PROCEDURES BEING PERFORMED BY PHYSICIANS AND NURSES USED ON HOSPITAL AEROMEDICAL EVACUATION SERVICES. Thomas F, Clemmer TP, Orme JF. Aviat Space Environ Med 1985; 56:1213-1215. Questionnaires were sent to 71 hospitals having rotor or fixed-wing aeromedical evacuation