Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management

George C. Velmahos, Constantinos Constantinou, Areti Tillou, Carlos V. Brown, Ali Salim, Demetrios Demetriades, David V. Feliciano, Michael R. Rotondo, Renato S. Poggetti, Charles E. Lucas, George C. Velmahos

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background: Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown. Methods: Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded. Results: One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without post-operative complications. Three CT scans were false-positive and resulted in non-therapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning. Conclusion: Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.

Original languageEnglish (US)
Pages (from-to)1155-1161
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number5
DOIs
StatePublished - Nov 2005

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Gunshot Wounds
Abdomen
Laparotomy
Sensitivity and Specificity
Wounds and Injuries

Keywords

  • Computed tomography
  • Gunshot wound
  • Nonoperative management
  • Penetrating abdominal trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management. / Velmahos, George C.; Constantinou, Constantinos; Tillou, Areti; Brown, Carlos V.; Salim, Ali; Demetriades, Demetrios; Feliciano, David V.; Rotondo, Michael R.; Poggetti, Renato S.; Lucas, Charles E.; Velmahos, George C.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 5, 11.2005, p. 1155-1161.

Research output: Contribution to journalArticle

Velmahos, GC, Constantinou, C, Tillou, A, Brown, CV, Salim, A, Demetriades, D, Feliciano, DV, Rotondo, MR, Poggetti, RS, Lucas, CE & Velmahos, GC 2005, 'Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management', Journal of Trauma - Injury, Infection and Critical Care, vol. 59, no. 5, pp. 1155-1161. https://doi.org/10.1097/01.ta.0000196435.18073.6d
Velmahos, George C. ; Constantinou, Constantinos ; Tillou, Areti ; Brown, Carlos V. ; Salim, Ali ; Demetriades, Demetrios ; Feliciano, David V. ; Rotondo, Michael R. ; Poggetti, Renato S. ; Lucas, Charles E. ; Velmahos, George C. / Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 5. pp. 1155-1161.
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abstract = "Background: Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown. Methods: Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded. Results: One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19{\%}). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without post-operative complications. Three CT scans were false-positive and resulted in non-therapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5{\%} and 96{\%}, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning. Conclusion: Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.",
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AU - Constantinou, Constantinos

AU - Tillou, Areti

AU - Brown, Carlos V.

AU - Salim, Ali

AU - Demetriades, Demetrios

AU - Feliciano, David V.

AU - Rotondo, Michael R.

AU - Poggetti, Renato S.

AU - Lucas, Charles E.

AU - Velmahos, George C.

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N2 - Background: Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown. Methods: Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded. Results: One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without post-operative complications. Three CT scans were false-positive and resulted in non-therapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning. Conclusion: Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.

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KW - Computed tomography

KW - Gunshot wound

KW - Nonoperative management

KW - Penetrating abdominal trauma

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