An evaluation of multidetector computed tomography in detecting pancreatic injury

results of a multicenter AAST study.

Herb A. Phelan, George C. Velmahos, Gregory J. Jurkovich, Randall S. Friese, Joseph P. Minei, Jay A. Menaker, Allan Philp, Heather L. Evans, Martin L. Gunn, Alexander L. Eastman, Susan E. Rowell, Carrie E. Allison, Ronald L. Barbosa, Scott H. Norwood, Malek Tabbara, Christopher J. Dente, Matthew M. Carrick, Matthew J. Wall, Jim Feeney, Patrick J. O'Neill & 16 others Gujjarappa Srinivas, Carlos V R Brown, Andrew C. Reifsnyder, Moustafa O. Hassan, Scott Albert, Jose L. Pascual, Michelle Strong, Forrest O. Moore, David A. Spain, Mary Anne Purtill, Byard Edwards, Jason Strauss, Rodney M. Durham, Juan C. Duchesne, Patrick Greiffenstein, C. Clay Cothren

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI). METHODS: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm. RESULTS: Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96% were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1%, whereas 64-MDCT was 47.2%. For PDI, the sensitivities of 16- and 64-MDCT were 54.0% and 52.4%, respectively, with specificities of 94.8% for 16-MDCT scanners and 90.3% for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis. CONCLUSION: Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.

Original languageEnglish (US)
JournalThe Journal of trauma
Volume66
Issue number3
StatePublished - Mar 2009

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Multidetector Computed Tomography
Multicenter Studies
Wounds and Injuries

ASJC Scopus subject areas

  • Medicine(all)

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An evaluation of multidetector computed tomography in detecting pancreatic injury : results of a multicenter AAST study. / Phelan, Herb A.; Velmahos, George C.; Jurkovich, Gregory J.; Friese, Randall S.; Minei, Joseph P.; Menaker, Jay A.; Philp, Allan; Evans, Heather L.; Gunn, Martin L.; Eastman, Alexander L.; Rowell, Susan E.; Allison, Carrie E.; Barbosa, Ronald L.; Norwood, Scott H.; Tabbara, Malek; Dente, Christopher J.; Carrick, Matthew M.; Wall, Matthew J.; Feeney, Jim; O'Neill, Patrick J.; Srinivas, Gujjarappa; Brown, Carlos V R; Reifsnyder, Andrew C.; Hassan, Moustafa O.; Albert, Scott; Pascual, Jose L.; Strong, Michelle; Moore, Forrest O.; Spain, David A.; Purtill, Mary Anne; Edwards, Byard; Strauss, Jason; Durham, Rodney M.; Duchesne, Juan C.; Greiffenstein, Patrick; Cothren, C. Clay.

In: The Journal of trauma, Vol. 66, No. 3, 03.2009.

Research output: Contribution to journalArticle

Phelan, HA, Velmahos, GC, Jurkovich, GJ, Friese, RS, Minei, JP, Menaker, JA, Philp, A, Evans, HL, Gunn, ML, Eastman, AL, Rowell, SE, Allison, CE, Barbosa, RL, Norwood, SH, Tabbara, M, Dente, CJ, Carrick, MM, Wall, MJ, Feeney, J, O'Neill, PJ, Srinivas, G, Brown, CVR, Reifsnyder, AC, Hassan, MO, Albert, S, Pascual, JL, Strong, M, Moore, FO, Spain, DA, Purtill, MA, Edwards, B, Strauss, J, Durham, RM, Duchesne, JC, Greiffenstein, P & Cothren, CC 2009, 'An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.', The Journal of trauma, vol. 66, no. 3.
Phelan, Herb A. ; Velmahos, George C. ; Jurkovich, Gregory J. ; Friese, Randall S. ; Minei, Joseph P. ; Menaker, Jay A. ; Philp, Allan ; Evans, Heather L. ; Gunn, Martin L. ; Eastman, Alexander L. ; Rowell, Susan E. ; Allison, Carrie E. ; Barbosa, Ronald L. ; Norwood, Scott H. ; Tabbara, Malek ; Dente, Christopher J. ; Carrick, Matthew M. ; Wall, Matthew J. ; Feeney, Jim ; O'Neill, Patrick J. ; Srinivas, Gujjarappa ; Brown, Carlos V R ; Reifsnyder, Andrew C. ; Hassan, Moustafa O. ; Albert, Scott ; Pascual, Jose L. ; Strong, Michelle ; Moore, Forrest O. ; Spain, David A. ; Purtill, Mary Anne ; Edwards, Byard ; Strauss, Jason ; Durham, Rodney M. ; Duchesne, Juan C. ; Greiffenstein, Patrick ; Cothren, C. Clay. / An evaluation of multidetector computed tomography in detecting pancreatic injury : results of a multicenter AAST study. In: The Journal of trauma. 2009 ; Vol. 66, No. 3.
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title = "An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.",
abstract = "BACKGROUND: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI). METHODS: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm. RESULTS: Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96{\%} were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1{\%}, whereas 64-MDCT was 47.2{\%}. For PDI, the sensitivities of 16- and 64-MDCT were 54.0{\%} and 52.4{\%}, respectively, with specificities of 94.8{\%} for 16-MDCT scanners and 90.3{\%} for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis. CONCLUSION: Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.",
author = "Phelan, {Herb A.} and Velmahos, {George C.} and Jurkovich, {Gregory J.} and Friese, {Randall S.} and Minei, {Joseph P.} and Menaker, {Jay A.} and Allan Philp and Evans, {Heather L.} and Gunn, {Martin L.} and Eastman, {Alexander L.} and Rowell, {Susan E.} and Allison, {Carrie E.} and Barbosa, {Ronald L.} and Norwood, {Scott H.} and Malek Tabbara and Dente, {Christopher J.} and Carrick, {Matthew M.} and Wall, {Matthew J.} and Jim Feeney and O'Neill, {Patrick J.} and Gujjarappa Srinivas and Brown, {Carlos V R} and Reifsnyder, {Andrew C.} and Hassan, {Moustafa O.} and Scott Albert and Pascual, {Jose L.} and Michelle Strong and Moore, {Forrest O.} and Spain, {David A.} and Purtill, {Mary Anne} and Byard Edwards and Jason Strauss and Durham, {Rodney M.} and Duchesne, {Juan C.} and Patrick Greiffenstein and Cothren, {C. Clay}",
year = "2009",
month = "3",
language = "English (US)",
volume = "66",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
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number = "3",

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TY - JOUR

T1 - An evaluation of multidetector computed tomography in detecting pancreatic injury

T2 - results of a multicenter AAST study.

AU - Phelan, Herb A.

AU - Velmahos, George C.

AU - Jurkovich, Gregory J.

AU - Friese, Randall S.

AU - Minei, Joseph P.

AU - Menaker, Jay A.

AU - Philp, Allan

AU - Evans, Heather L.

AU - Gunn, Martin L.

AU - Eastman, Alexander L.

AU - Rowell, Susan E.

AU - Allison, Carrie E.

AU - Barbosa, Ronald L.

AU - Norwood, Scott H.

AU - Tabbara, Malek

AU - Dente, Christopher J.

AU - Carrick, Matthew M.

AU - Wall, Matthew J.

AU - Feeney, Jim

AU - O'Neill, Patrick J.

AU - Srinivas, Gujjarappa

AU - Brown, Carlos V R

AU - Reifsnyder, Andrew C.

AU - Hassan, Moustafa O.

AU - Albert, Scott

AU - Pascual, Jose L.

AU - Strong, Michelle

AU - Moore, Forrest O.

AU - Spain, David A.

AU - Purtill, Mary Anne

AU - Edwards, Byard

AU - Strauss, Jason

AU - Durham, Rodney M.

AU - Duchesne, Juan C.

AU - Greiffenstein, Patrick

AU - Cothren, C. Clay

PY - 2009/3

Y1 - 2009/3

N2 - BACKGROUND: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI). METHODS: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm. RESULTS: Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96% were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1%, whereas 64-MDCT was 47.2%. For PDI, the sensitivities of 16- and 64-MDCT were 54.0% and 52.4%, respectively, with specificities of 94.8% for 16-MDCT scanners and 90.3% for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis. CONCLUSION: Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.

AB - BACKGROUND: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI). METHODS: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm. RESULTS: Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96% were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1%, whereas 64-MDCT was 47.2%. For PDI, the sensitivities of 16- and 64-MDCT were 54.0% and 52.4%, respectively, with specificities of 94.8% for 16-MDCT scanners and 90.3% for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis. CONCLUSION: Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.

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M3 - Article

VL - 66

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

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