Appropriateness of CT of the Chest, Abdomen, and Pelvis in Motorized Blunt Force Trauma Patients Without Signs of Significant Injury
AJR:197, December 2011
Noam Ze'ev Millo Chris Plewes Brian H. Rowe Gavin Low
OBJECTIVE. The purpose of this article is to determine the frequency of clinically significant injuries detected on CT of the chest, abdomen, and pelvis in adult patients involved in motorized blunt force trauma with normal clinical examinations.
MATERIALS AND METHODS. A retrospective review of the medical records of patients presenting with a triage history of motorized blunt force trauma who underwent CT of the chest, abdomen, and pelvis at the time of presentation was performed. Hemodynamically stable adult patients without abnormal physical examination findings to suggest injury of the trunk (e.g., tenderness, deformity, or bruising over the chest, abdomen, or pelvis) were included in the study. The formal report of the CT scan was reviewed and all acute injuries were recorded. Admission and discharge dates and surgical interventions were also recorded.
RESULTS. Records for 542 patients were reviewed; 108 patients (74 men and 34 women; median age, 36 years) fulfilled the inclusion criteria. Eleven of the 108 patients (10%; 95% CI, 4.4-15.6%) had acute injuries detected on CT of the chest, abdomen, and pelvis. None of the injuries required direct medical intervention. Alcohol intoxication or distracting injuries were present in eight of these patients. The median time in hospital, from emergency department pre-sentation to discharge, was 4.4 days (interquartile range, 2.5-8.5 days) for patients who were admitted and 6.7 hours (interquartile range, 4.8-10.3 hours) for those who were discharged.
CONCLUSION. The clinical yield of performing CT of the chest, abdomen, and pelvis in motorized blunt trauma patients with normal clinical examinations in our study was minimal.