TY - JOUR
T1 - Limiting computed tomography to patients with peritoneal lavage-positive results reduces cost and unnecessary celiotomies in blunt trauma
AU - Schreiber, Martin A.
AU - Gentilello, Larry M.
AU - Rhee, Peter
AU - Jurkovich, Gregory J.
AU - Maier, Ronald V.
PY - 1996/9
Y1 - 1996/9
N2 - Objective: To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy. Design: Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 1011/L (105/mm3) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy. Results: Sixty-seven hemodynamically stable patients had a red blood cell count greater than 1011/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P<.01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580 594 over a period of 2 years. Conclusion: Limiting CT to the evaluation of patients with DPL- positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of non-therapeutic celiotomies compared with DPL alone.
AB - Objective: To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy. Design: Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 1011/L (105/mm3) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy. Results: Sixty-seven hemodynamically stable patients had a red blood cell count greater than 1011/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P<.01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580 594 over a period of 2 years. Conclusion: Limiting CT to the evaluation of patients with DPL- positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of non-therapeutic celiotomies compared with DPL alone.
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U2 - 10.1001/archsurg.1996.01430210052010
DO - 10.1001/archsurg.1996.01430210052010
M3 - Article
C2 - 8790181
AN - SCOPUS:0029781572
SN - 0004-0010
VL - 131
SP - 954
EP - 959
JO - Archives of Surgery
JF - Archives of Surgery
IS - 9
ER -