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Routine computed tomography after recent operative exploration for penetrating trauma

What injuries do we miss?

Mendoza, April E. MD; Wybourn, Christopher A. MD; Charles, Anthony G. MD; Campbell, Andre R. MD; Cairns, Bruce A. MD; Knudson, Margaret M. MD

Journal of Trauma and Acute Care Surgery: October 2017 - Volume 83 - Issue 4 - p 575–578
doi: 10.1097/TA.0000000000001558
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BACKGROUND Patients with penetrating trauma who cannot be stabilized undergo operative intervention without preoperative imaging. In such cases, postoperative imaging may reveal additional injuries not identified during the initial operative exploration. The purpose of this study is to explore the utility of postoperative CT imaging in the setting of penetrating trauma.

METHODS This was a retrospective analysis of patients with penetrating trauma treated at an urban Level 1 trauma center between 2010 and 2015. Patients were included if they underwent an emergent laparotomy without preoperative imaging. Patients were excluded if they had prior imaging or concomitant blunt injury. For the purposes of this study, occult injury was defined as a CT scan finding not mentioned in the first operative report. Descriptive statistics were used to compare patient characteristics who had received imaging immediately postoperatively with those who had not.

RESULTS During the 5-year study period, 328 patients who had a laparotomy for penetrating trauma over the study period, 225 patients met the inclusion criteria. Seventy-three (32%) patients underwent CT scanning immediately postoperatively with occult injuries identified in 38 (52%) patients. The most frequent occult injuries were orthopedic (20 of 43) and genitourinary (9 of 43). Importantly, 10 (26%) of the 38 patients required an intervention for these occult injuries. Those selected for immediate postoperative imaging were more likely to have sustained gunshot wounds and were significantly more severely injured (higher Injury Severity Score and longer length of hospital stay) when compared to patients who did not receive immediate imaging.

CONCLUSION We recommend the use of immediate postoperative CT after emergent laparotomy especially when there is a high index of suspicion for spine or genitourinary injuries and in patients who have sustained ballistic penetrating injuries.

LEVEL OF EVIDENCE Therapeutic/care management, level IV; diagnostic tests or criteria, level IV.

From the Division of Trauma and Critical Care, Department of Surgery (A.E.M., C.A.W., A.C., M.M.K.), University of California San Francisco, San Francisco, California; and Department of Surgery (A.G.C., B.A.C.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Submitted: June 30, 2016, Revised: April 12, 2017, Accepted: April 23, 2017, Published online: May 11, 2017.

Address for reprints: April E. Mendoza, MD, MPH, San Francisco General Hospital, 1001 Potrero Avenue, Ward 3A, San Francisco, California 94110; email: April.mendoza@ucsf.edu.

© 2017 Lippincott Williams & Wilkins, Inc.