Mackenzie R Cook1, John B Holcomb2, Mohammad H Rahbar3, Erin E Fox2, Louis H Alarcon4, Eileen M Bulger5, Karen J Brasel6, Martin A Schreiber6. 1. Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L611, Portland, OR 97239, USA. Electronic address: cookmac@ohsu.edu. 2. Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA. 3. Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA. 4. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 5. Department of Surgery, University of Washington, Seattle, WA, USA. 6. Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L611, Portland, OR 97239, USA.
Abstract
BACKGROUND: Positive Focused Assessment with Sonography in Trauma examination and hypotension often indicate urgent surgery. An abdomen/pelvis computed tomography (apCT) may allow less invasive management but the delay may be associated with adverse outcomes. METHODS: Patients in the Prospective Observational Multicenter Major Trauma Transfusion study with hypotension and a positive Focused Assessment with Sonography in Trauma (HF+) examination who underwent a CT (apCT+) were compared with those who did not. RESULTS: Of the 92 HF+ identified, 32 (35%) underwent apCT during initial evaluation and apCT was associated with decreased odds of an emergency operation (odds ratio .11, 95% confidence interval .001 to .116) and increased odds of angiographic intervention (odds ratio 14.3, 95% confidence interval 1.5 to 135). There was no significant difference in 30-day mortality or need for dialysis. CONCLUSIONS: An apCT in HF+ patients is associated with reduced odds of emergency surgery, but not mortality. Select HF+ patients can safely undergo apCT to obtain clinically useful information.
BACKGROUND: Positive Focused Assessment with Sonography in Trauma examination and hypotension often indicate urgent surgery. An abdomen/pelvis computed tomography (apCT) may allow less invasive management but the delay may be associated with adverse outcomes. METHODS:Patients in the Prospective Observational Multicenter Major Trauma Transfusion study with hypotension and a positive Focused Assessment with Sonography in Trauma (HF+) examination who underwent a CT (apCT+) were compared with those who did not. RESULTS: Of the 92 HF+ identified, 32 (35%) underwent apCT during initial evaluation and apCT was associated with decreased odds of an emergency operation (odds ratio .11, 95% confidence interval .001 to .116) and increased odds of angiographic intervention (odds ratio 14.3, 95% confidence interval 1.5 to 135). There was no significant difference in 30-day mortality or need for dialysis. CONCLUSIONS: An apCT in HF+ patients is associated with reduced odds of emergency surgery, but not mortality. Select HF+ patients can safely undergo apCT to obtain clinically useful information.
Authors: Paul A Fuchs; Deborah J del Junco; Erin E Fox; John B Holcomb; Mohammad H Rahbar; Charles A Wade; Louis H Alarcon; Karen J Brasel; Eileen M Bulger; Mitchell J Cohen; John G Myers; Peter Muskat; Herb A Phelan; Martin A Schreiber; Bryan A Cotton Journal: J Trauma Acute Care Surg Date: 2013-07 Impact factor: 3.313
Authors: T M Scalea; A Rodriguez; W C Chiu; F D Brenneman; W F Fallon; K Kato; M G McKenney; M L Nerlich; M G Ochsner; H Yoshii Journal: J Trauma Date: 1999-03
Authors: Gwendolyn M van der Wilden; George C Velmahos; Timothy Emhoff; Samielle Brancato; Charles Adams; Georgios Georgakis; Lenworth Jacobs; Ronald Gross; Suresh Agarwal; Peter Burke; Adrian A Maung; Dirk C Johnson; Robert Winchell; Jonathan Gates; Walter Cholewczynski; Michael Rosenblatt; Yuchiao Chang Journal: Arch Surg Date: 2012-05
Authors: Ulrich Linsenmaier; Michael Krötz; Hannes Häuser; Clemens Rock; Johannes Rieger; Klaus Bohndorf; Klaus Jürgen Pfeifer; Maximilian Reiser Journal: Eur Radiol Date: 2001-12-13 Impact factor: 5.315
Authors: Dirk Stengel; Johannes Leisterer; Paula Ferrada; Axel Ekkernkamp; Sven Mutze; Alexander Hoenning Journal: Cochrane Database Syst Rev Date: 2018-12-12