Imaging Negative Predictive Value High for Blunt Trauma
Multidetector computed tomography accurately detects blunt trauma, but is operator dependent
THURSDAY, Oct. 23 (HealthDay News) -- Surgically important bowel and mesenteric injuries can be identified with multidetector computed tomography (CT), but ability to detect injury is related to experience, according to a report in the November issue of Radiology.
Mostafa Atri, M.D., of the University of Toronto in Ontario, Canada, and colleagues performed a retrospective case-control study of subjects with laparotomy-confirmed surgical findings examining the ability of multidetector CT to detect significant surgical blunt bowel and/or mesenteric injury, to describe reliable CT features of the injury, and to evaluate different levels of expertise in interpreting the multidetector CT scan. Overall, 54 consecutive patients with bowel and/or mesenteric injury were matched to 42 patients without bowel and/or mesenteric injury, with all receiving a multidetector CT scan prior to surgery. All CT studies were blindly and independently interpreted by a second-year radiology resident, an abdominal imaging fellow and a staff abdominal radiologist.
Surgically important bowel and/or mesenteric injury was present in 38 patients (40 percent), while 58 patients (60 percent) had either no or surgically unimportant bowel and/or mesenteric injury, the researchers report. Sensitivities for the diagnosis of surgically important bowel and/or mesenteric injury ranged from 87 percent to 95 percent, while specificity ranged from 48 percent to 84 percent, the report indicates. Staff radiologists were only significantly better in detecting mesenteric injury, and areas under the receiver operating characteristic curves, a better reflection of overall performance, did not demonstrate a significant difference based on experience, the authors note.
"In conclusion, we believe that multidetector CT is accurate in the diagnosis of surgically important bowel and mesenteric injuries complicating blunt abdominal trauma," the authors conclude. "We suggest 12-hour follow-up CT to improve specificity if non-specific findings of bowel and/or mesenteric injury are present and the patient is in stable condition and has no other indication for surgery."