•Hospital-based study conducted from MAY 2004 to JAN 2008.
•164 consecutive patients who presented blunt trauma and undervent abdominopelvic CT for evaluation were included.
Selection Criteria of the patient:
•Patients with blunt abdominal trauma who underwent CT for evaluation of intra-abdominal injury prior to surgery.
Exclusion Criteria of the patient:
•Patients who did not have a follow up (laparotomy / follow up imaging if managed conservatively) were excluded.
Selection Criteria of the patient:
•Patients with blunt abdominal trauma who underwent CT for evaluation of intra-abdominal injury prior to surgery.
Exclusion Criteria of the patient:
•Patients who did not have a follow up (laparotomy / follow up imaging if managed conservatively) were excluded.
•Patients had Shock index (SI) recorded on arrival and then their final disposition.
•Doccumentaion of the CT free fluid score (FFS) and inferior vena cava (IVC) status was done.
•Patients were grouped into three groups :
Group 1 : based on SI,
Group 2 : based on IVC status,
Group 3: based on FFS.
General physical examination:
In this examination particular attention was given for the examination of components which require immediate correction such as component of shock indicator & overall to see whether the patients are hemodynamically stable or unstable so as to decide conservative or surgical management.
Pulse:
This was taken at the time of admission. A pulse of > 100 / min was taken as tachycardia.
Pulse > 100 / < 100
Blood Pressure:
This was taken at the time of admission. A BP >90mm Hg was labeled as hemodynamically stable.
BP >100 / < 100
Shock index:
Shock index was calculated from the ratio of heart rate to systolic BP. Categorization done on the basis of the SI:
0.5 - 0.7: normal
0.7 – 0.9: borderline
0.9: hemodynamically unstable i.e. Shock.
Shock index > 0.9 / < 0.9
Hemodynamically Stable / Unstable
CT quantification of hemoperitoneum (Federle et al):
Description | Estimates | Approximate amount |
Fluid in only space | Small (I) | 100-200 ml |
Fluid in two or more spaces | Moderate (II) | 250 – 500 ml |
Fluid in all spaces or pelvic fluid anterior/ superior to urinary bladder | Large (III) | >500 ml |
Location of hemoperitoneum: 1. Perisplenic space, 2. Perihepatic space, 3. Morison’s pouch, 4. paracolic gutters, 5. Cul-de-sac in pelvis.
FLAT IVC:
•The IVC is considered to be flat if its anteroposterior width below the level of the renal vein is less than one-fourth of its lateral width and the change is not caused by external compression.
•Hypovolemia, poor fluid resuscitation, or shock may manifest as a flattened IVC at CT.
•Wong et al, 2003195 reported that none of the patients in their study who responded to conservative treatment had a flat IVC, whereas 29.6% who required interventional treatment had a flat IVC at initial CT.
•Patients outcome was correlated as operative management (NOM) vs nonoperative management (NOM) within these groups and the statistical sigficance was calculated based on the odds ratio, student t test and kappa value.
CT AND MANAGEMENT CORRELATION:
The accuracy of the CT was evaluated on the basis of the final radiology report which were compared with either
1) Findings at laparotomy
2) Findings at follow up imaging if managed conservatively.
MANAGEMENT:
Conservative: yes/no
Follow up: recovered / deteriorated / died
OPERATIVE:
Emergency laparotomy yes/no
Emergency laparoscopy yes/no
Delayed laparotomy / laparoscopy yes/no
If operated: AAST & CT finding correlation
Follow up: recovered / deteriorated / died