Mahery Raharimanantsoa1, Tobias Zingg2, Alicia Thiery3, Cécile Brigand1, Jean-Baptiste Delhorme1, Benoît Romain4. 1. Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000, Strasbourg, France. 2. Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. 3. Department of Public Health Care, Strasbourg University, 67000, Strasbourg, France. 4. Department of Digestive Surgery, Strasbourg University, 1 Avenue Moliere, 67000, Strasbourg, France. ben.romain@hotmail.fr.
Abstract
PURPOSE: Blunt bowel and mesenteric injuries (BBMI) are regularly missed by abdominal computed tomography (CT) scans. The aim of this study was to develop a risk assessment tool for BBMI to help clinicians in decision-making for blunt trauma after road traffic crashes (RTCs). METHODS: Single-center retrospective study of trauma patients from January 2010 to April 2015. All patients admitted to our hospital after blunt trauma following RTCs and CT scan at admission were assessed. RESULTS: Of the 394 patients included, 78 (19.8%) required surgical exploration and 34 (43.6%) of these had a significant BBMI. A univariate and multivariate analysis were performed comparing patients with BBMI (n = 34) and patients without BBMI (n = 360). A score with a range from 0 to 13 was created. Scores from 8 to 9 were associated with 5-25% BBMI risk. The power of this new score ≥ 8 to predict a surgically significant BBMI had a sensitivity of 96%, specificity of 86.4%, positive predictive value (PPV) of 48% and negative predictive value (NPV) of 99.4%. CONCLUSION: This score could be a valuable tool for the management of blunt trauma patients after RTA without a clear indication for laparotomy but at risk for BBMI. The outcome of this study suggests selective diagnostic laparoscopy for a score ≥ 8 in obtunded patients and ≥ 10 in all other. To assess the value and accuracy of this new score, a prospective validation of these retrospective findings is due.
PURPOSE:Blunt bowel and mesenteric injuries (BBMI) are regularly missed by abdominal computed tomography (CT) scans. The aim of this study was to develop a risk assessment tool for BBMI to help clinicians in decision-making for blunt trauma after road traffic crashes (RTCs). METHODS: Single-center retrospective study of traumapatients from January 2010 to April 2015. All patients admitted to our hospital after blunt trauma following RTCs and CT scan at admission were assessed. RESULTS: Of the 394 patients included, 78 (19.8%) required surgical exploration and 34 (43.6%) of these had a significant BBMI. A univariate and multivariate analysis were performed comparing patients with BBMI (n = 34) and patients without BBMI (n = 360). A score with a range from 0 to 13 was created. Scores from 8 to 9 were associated with 5-25% BBMI risk. The power of this new score ≥ 8 to predict a surgically significant BBMI had a sensitivity of 96%, specificity of 86.4%, positive predictive value (PPV) of 48% and negative predictive value (NPV) of 99.4%. CONCLUSION: This score could be a valuable tool for the management of blunt traumapatients after RTA without a clear indication for laparotomy but at risk for BBMI. The outcome of this study suggests selective diagnostic laparoscopy for a score ≥ 8 in obtunded patients and ≥ 10 in all other. To assess the value and accuracy of this new score, a prospective validation of these retrospective findings is due.
Authors: Edward L Jones; Robert T Stovall; Teresa S Jones; Denis D Bensard; Clay Cothren Burlew; Jeffrey L Johnson; Gregory Jerry Jurkovich; Carlton C Barnett; Frederic M Pieracci; Walter L Biffl; Ernest E Moore Journal: J Trauma Acute Care Surg Date: 2014-04 Impact factor: 3.313
Authors: Tim C Jansen; Jasper van Bommel; Paul G Mulder; Johannes H Rommes; Selma J M Schieveld; Jan Bakker Journal: Crit Care Date: 2008-12-17 Impact factor: 9.097