A prospective study comparing nuclear scintigraphy and computerized axial tomography in the initial evaluation of the trauma patient.

Eighty-five consecutive patients admitted for trauma evaluation and fulfilling criteria suggesting the possibility of intra-abdominal injury underwent both immediate computerized axial tomography of the abdomen and a nuclear medicine evaluation, including a liver-spleen scan with or without a renal scan, in order to delineate their injuries and direct management. The limitations, advantages, and complementary use of each modality in the initial evaluation of the trauma patient is described. Overall, nuclear scintigraphy excelled in instances of contusion, in the evaluation of the restless or uncooperative patient, and in children. With computerized tomography, the retroperitoneal structures were well defined and multiple abdominal injuries could be seen. Neither modality demonstrated the presence of intra-abdominal fluid consistently. No patient with assumed isolated liver, spleen, or renal injury on the basis of the above studies, who was managed nonoperatively, required subsequent laparotomy.