67

Di agnOSt i C aCCU Cy Of CT SCa n i n abdomi nal bI unt t uma

Ja d Sabm Khadyj eh Ba t avar Mehdi s obman| Pat nci a Khas hayar A Pa s ha Meys a mi e an d M00s a Zar 9ar

obj ec t i Ve 1 o eVa l ua t e t 11e s ens i ti Vi t ) al l d spe ci f i ci ca l cul a t ed i n e ac h c as e

of CT sc a n f i i ndi ngs i n pat i en t s wi bl unt abdoI Il i nal uma R uI t s CT s c aI l had t 11e hi gI l est se nsi t i v f j Dr det e ct -
a dmi t t ed t o t h e un i v er s i t y hospi t al me i e s t o l i Ve r( 100 ) d sp l een ( 86 6 ) Th e s peci
Met hods Al l t h e Dat i ent s wi mbl un t a_bdomi I l al aum f i cit V of me memod f or det ect i I l g r e t r o pc t o nea l he ma t oma

a dmi t t ed a t a t eI ti ar y t ea cl l i n2 auma ce nt e r i n Ir a Il bet ween ( 100 ) and i nj ur i es to 1ddI l ey( 93 5 ) was hi ghe r t han ot he r
2005 and2007wer een r 01l edi nt hi s st udv I I l t l l eab senc e of or g s The accu mcy of CT i mages t o de t ec t me i ni ur i es t o

y cl i ni cal mani f e st a t i ons me pat i en t s unden e nt a di ag spl een l i Ver hdne y l d r et l per i t on eal he ma t oma wa s rc

no st i c Cr s can Lapar at omy wa s pe r f bme d i n t hose wi t h pon t obe 96 1 94 4 91 6 d91 6 r es p c vel y

Dos i t i v e CT r e sul t s o t her s wer e 0b sen e d f o r 48 hour s d ConcI usi on Th e f i ndi ng s of t h e pr e s ent s t udy r eve a l

di sch ed i n ca s e no pmbl em wa s r epor t ed o t l l en i s e t }ley t h at CT s c an c oul d be c ons i de r ed as a good ch oi ce e spe

und er we nt 1a pa r a t omy I nfor ma t i on on pat i e nt s demo ci al l y f o r pat i en t s wi t t l bl un t abdom

i nal t r auma i n t ea c hi ng

gr ap l l i c dat a me chal l i sm of uma' i ndi cat i on f o r CT s ca n ho spi t al s wher e t h e r a di ol o c aca del l l i c st a i s not pr e se nt

CT sc fi ndi ngs r esul t s of 1ap t omy wer e gamer ed The i n t h e hos pi t al i n me ni ght s hi f t s

sensi t i Vi t y spe ci i t y and a c cur ac y of t h e CT_s can i mages Key wor ds Wro c no e Pf r n Hg A dbmi n Z
i n r egar d wi t h t h e or gan i nj ure d wer e c al c ul a t e d The i nj H^es I bmog pb x- r n compmed D gnos
sen si t i Vi t y spec i f i ci t y and a c cur ac y of me CT s c an wer c

l u nt abdOmi na I t r aUma may r epr eSent a fe si On t O hos Di t aI 3- 4 Ab dOmi na I e a mi nat i On i S Of t en c om-

B t hr e a t e ni ng c Ondi t i on r e qu i r | ng r a pi d di agnos i s
an d t r eat ment

t r a- abdomi naI i nj u is a
The di agnos i s 0f si gni f i can t i n-

cha enge i n t he ma na ge me nt
pOunded by di
c hes t nbs
e r en t f a ct Or s i nc I udi ng f r a ct ur es of 10we r

nt usi On an d a bra Si ons 0f t he abdOmi nal wa l I

pr es enc e 0f f r a ct ur ed I umbar ve r e br ae wi t h r et r op er j t o -

Of s u ch pat ient S 1 2 Fa ur e t O r ecOgni ze an d t r ea t 0C nea I he ma t Oma and r edu ced I ev eI Of cOns ci Ous nes S

CuI t he mOr r haa e i s a cOmmOn mi s t ake The c ni caI hi s - Rap i d a sse s sme nt an d a ppr opr i at e t r eat ment Of pot en-

t Or y a nd phySi CaI exami nat i on al One ar e us ual I y t i aII y I i f e t hr eat eni n g c ondi t i ons i s t her e f or e esse nt j aI 5

Unr e l i abI e a s ne anVha l f t he pat i e nt s may hav e nO m- The Opt i mal met hod 0f e val u at ng abd Omi n al t uma r e-

pI ai nt s or e) ( t er n aI s j gns 0f abd omi n aI i ni u on admi s - ma i nS c ont rove r si aI A combi n a On Of a s enSi t i ve an d

spe ci f i c s cr eeni ng t e st may be a s af e an d e i ci e nt ap-

pr o ach t o i t Di agnos t i c per i t one al I a Va ge ( DPL) i s an

DOI 10 37 60 cma i i ssn 10 08- 1 275 200 9 0 2 0 01
acc ept ab I e met hOd f o r de t e c t i ng t he i nt r a- pe r - t OneaI
Si na Tr auma &Su r ger y Re se a r ch Cent er Si na
f I ui d I t ha s s ens i t i v gr eat er t han 90 f or t he det ec-
HOspi t al M
e di ca I Sci ence s Uni ver si t y 0f Tehr an r ehr an
I r an( Sa| I mi J an d Za r aa r M) t i on of hemOper i t o neum but i t i s nOt spec f i c 0r r e abI e

Sj na Hos pi t a I Medi c aI Sci ences Uni ver s of Teh n f or 1e as se ssment 0f net nope nt one a Ii ni u r i es I n addi t i on

n hr an I r an( Bakht a var Kan d So ma ni M) ke a ny i nva Si ve pr 0 CedUr e DPL Ca r r I e S SOme r SkS 6

Res ea r ch an d De vel opmen t Ce nt e r Si na HOspi t aI The us e 0f Foc us ed As s e s sme nt SOnOgr a phy f Or
Medi c aI Sci ences UnI ver sj t y Of Tbhr an r ehr a n I ra n
T auma(FAST)f or uns t abl e pat Ie nt s w t h i nt -abdomi
( Khas hayar P)
naI hemor r ha ge r at her t han i ni ur y ha s dr amat i cal I y
Medi c al Sci enc es Uni ve r si t y Of Tehr a n Te hr a n I n
( Me ys ami e AP) c ha nged t he met hOds f Or di agn os j na bI unt ab domi na I

COrr e spondi ng a ut hOr s r e I&Fax 98-21-6673501 8 t r auma 7 CT s c an i s nOwcons i der ed as a r api d means

E- ma mi sa| mi @
si na t ums ac ir Of a ss e ss me nt f Or t he e a r Iy del ect i on Of i nt r a- pe r t O-

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 68 ch i ne Jou ma| o f 1 umatol 09y 20 09 12 ) 67 70

ne aI i nj ury whi c h i s not de pen den t on t he oper at o r 8 As sp ecI f i ci t y an d ac cu c y 0f t he CT scan i mage i n

a r es uI t t hi s s t udy waS COn duCt ed t O evaIuat e t he s pe c i - aar d wi t h t he or q an i ni ure d we cal cul at ed The s ens

f ic i ty an d se nsi t i Vi t y of C r - sca n f i ndi ngs i n pat i e nt s wi t h ti it y was def n ed as t he abi I i t y of CT s c an t O det e ct an

bI unt ab domi na I t r auma i n or de r t o ve r t he acc ur a Cy i nj ur y i f pr es ent and was caI cul at ed by di Vi dI ng t he

0f t he met hOd as a non- 0pe r at Or dependa nt met hod number of t rLJe pOsi t i v e CT s c an by t he number of pOs -

whi Ch COuI d be us ed by r es i de nt s i n t he t eachi ng hOS- t i v e I apar ot omi es The spe ci f i c was de f ne d as t he

pi t aI s whe r e a cade mi c St a ar e abs e nt s pe ci aI I y i n t he abI t y of CT s c an t o r u I e out a n i ni ur y none exi st ed

ni a ht Shi f ts an d f va s ca I CuI a e d by di vi di n g t he number Of t r ue nega-

t i v e CT s c ans by t he number of pat i e nt s wi t hout i ni ury

METHODS Fi na V t h e acc ur a cy Of t he C T s c an was det er mi n ed

by di vi di ng t he s um 0f t r ue pos i t i ve an d t r ue negat i ve

Af t e r aDpr ovaI by t he I n St i t u t i Ona I Et hi c al BOa r d CT SCanS by t ot aI number of CT s Ca ns per f or med The

COmmi t t ee a t he pat i e nt s wi t h bI un t abd Omi n al t r auma dat a wer e ent er ed i n SPSS ver s i on 1 3 St uden t s He s t

admi t t ed at a t er t i ar y t eachi ng t r auma cent er i n I r a n a nd Chi - s aua r e anaI ys i s we r e us e d t 0 an aI yz e t he

bet we en 2005 an d 2007 wer e evaI uat ed Th os e whO va na bI e S

unden^ e nt a C T s c an wer e e nr o ed j n t h i s st udV I ndi -

c at i ons f o r ab domi na I CT s c an wer e as f ol I ows 1) ab- RESULTS

domen pe| V c pai Men demes s 2) vi s _bI e abdomen pe| -

vi s t uma 3) hi s t or y of homodyna mi c i nSt abi t y( SBP One hu ndne d pat i e nt S wer e e nro e d i n t hi S St ud y

<80 mmHg) 4) hemat ur i a 5) abnor ma I peI Vi c x r ay 6) 87 0f wh omwe ma I e an d 13 we r e f emaI e The pe ak

a l c ohoI i nt oxj c at i on 7) unre abIe exami n a on s e cond - a ge was 20 40 year s ( 43 ) a nd fo owed by pat i ent s

a ry t o di st r a ct i ng i nj u r es unr e spons i Ve nes s an d neu age d mor e t han 40 year s ( 24 ) Pat i ent s a ged 1 O- 1 9

r oI ogi ca l i nj ur y 8) decr eas ed men t aI st at e( GCS<9 ) year s acc ount ed f o r 21 0f t he a dmi SSi OnS
I os s of cons ci ous nes s 1 0) m echani s m of i nj ur y( hi gh
s peed ener gy a cc i de nt e xt e ns i Ve dama ge t 0 Veh i cI e Ac ci dent ( 63 ) and f a ( 22 ) wer e t he most f r e-

f a t a I I t i e s i nvol ved) 1 1) i nt uba t i ons a nd 1 2) peI vi c que nt mec ha ni sm 0f t r auma i n t hes e pat i e nt s The Vi taI

f c ur es s i gns we r e r eVeaI ed t 0 be uns t abI e at t he admj s s i On

tI ne i n 77 Of t he pat i e nt s

CT s c an i ma ges wer e vi e wed by a r es i dent Of

di 0I Ogy whO was b n d t 0 t he pat i e nt s c ondi 0n a nd Thi r t y si x Of t he pa t i e nt s unde n^ e nt l apa rOt omy

una wa r e of t he obi ect i ves of t he s t udy CT s ca n was Si t y wer e di s cha r ged f o owi ng cI os e obs er Vat i on i n

cOns i der ed pOsi t i ve if One Of t he f O Owi ng cr i t e r a was 48 hou 3 wer e f er r ed t O 0t he r cent er S and I di e d

me t 1) t r a uma of so d organs ( Ver s pI een ki dney bef or e Ope r at i On

a nd pa nc r ea s) 2) t r auma of s ma l | Int e st i ne c oI on

mes ent er y di aph gm or bIadder 3) det ect abI e a mount r ot a y 7 pat i e nt s di ed du r ng t he s t udy pe r Od 6 0f

0f f r e e f I ui d wi t h hemor r r l age i n abdOmen an d peI vis whomwe r e 0pe t ed upOn Lapar ot omy VeaI ed s pl een

r upt ur e( 4 ca se s) l i Ve r r upt ur e( 2 cas es ) duodenal an d

Lapa r ot Omy was done f o r a t he pat i e nt s wi t h an y pancr eat i c r upt u r e( 2 cas es) s ma i nt es t i ne ki dney
evi denc es of i nt r a a bdomi nal an d peI vi c i ni unes In t he a nd me se nt e r ic r upt ur e( 3 c as es ) a nd r et nope r t oneaI
a bs e nce 0f a ny c ni ca I mani f es t at i ons t 11e pat i ent s he ma t oma( 2 cas es ) on e deat h oCCur r ed i n t he eme r -
unden ent a di a gnOs c CT s can Lapar {l t omy was pe r - ge nc y dep ar t me nt wh e ot her s happe ned i n I ( U Th e

f o r me d i n t hOs e wi t h D0si t i ve CT r e s uI t s wh e Ot her s mean t i me 0f deat h wa s pOr t ed t o be 26 hour s f oI l0Vv-

we r e 0bs e n ed f or 48 hOu an d we di s ch ar ge d i n c e i n g a dmi s si on

n0 pr obI e mwaS neport e d 0t he n i se t hey unde n^ e nt

I apa 0my N0 s pe c ic ndi ngs we r e n pOr t ed i n t he C sc an 0f

29 of t he pat i ent s Am
Ong t he m s u r ge was per f Oml ed
1nf onl l at i on On pat i ent s demOgr aphi c dat a mecha- i n one ca e( 3 4 ) TWo of t hes e pa t i ent s wer e r efe r r
ni s m 0f t uma i ndI ca t i on f or CT s can CT s ca n f i ndi ngs t 0 0t he r cen t e a nd 26 we di s char ged ( ) f t he 71 pa-
s uIt s 0f I apar at omi es was gat he d The sensi t i V t i ent s who ha d po si t i Ve CT s can 1( 1 4 ) was r ef e r r ed

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c Tjne D l a 67 7D
an d 1 di ed TabI e 2 POsi Ve and ne gat i ve pr ed Ve vaI ues 0f CT s c an
- T11i r t y- s i x und er we nt an Ope r a t i On whi I e 33

) we dIscharged wi t hout be i ng oper at ed up on

Acc or di ng t 0 t he r e sul t s 0f t he pr es ent s t udy C r

s ca n ha d t he hi ghes t se nsi t i vi t y f or de t e Ct i ng t he i ni u-

ne s t o ver (1 00 ) s pIeen( 86 6 ) ki dney( 80 )and

st oma Ch( 80 ) On t he c ont r ar y t he s peci f i c of t he

CT s ca n i maae s f or det e ct i na r e t r oper i t onea I he mat oma

(1 00 ) a nd i n i ur i e s t o ki dney( 93 5 ) and me s en t e

( 87 5 )was hi gher t han ot her organs( r abIe 1)

The acCur acy 0f CT j mage s t o det e ct t he j nj unes t0

sp l ee n l i v er ki dne V an d r et r ope nt One aI he ma t oma we r e

r epOr t ed t O be 96 1 94 4 91 6 and 91 6

nes pe ct i VeI y I n gene ra I t he sensi t i Vi t y spec f i ci t y an d

DI SCUSSI ON
accur acv we caI c uI at ed aS 63 9 82 1 and 77 2

s pecl i vel y
l n t he pas t 20 ye ar s C T ha s pr I ) ved t O be an e c eI -

I e nt i magi n g moda t y f Or di a gnos i ng a nd mana gi ng

The hi ghe st pos t i ve pr edi ct i ve vaI ue( PPV) was f or
hemo dynami ca y st abI e pat Iems wnh abdomi naI i ni unes 9
I i ver ( 83 3 ) and s pl ee n( 81 2 ) and over a 56 8
H0 weVer s On Ogr aph y i s I a r gel y us e d as t he p fer r ed
Si m ar I y I i ver ha d t he hi ghe st nega t i ve pnedi ct i ve vaI ue
SCr eeni ng t eChni qUe i n many t r auma c ent e r S The va l Ue
( NPV) ( 1 00 ) St omach ( 94 7 ) a nd coIon( 92 8 )
of so nogr aph y I n r eVe al i ng an or gan I nJ u Vanes g atI y
we r e t he or qan s wi t h t he ne) ( t hi ahes t NPV Over a
wi t h t he I Oc at i on Of t he I eSiOn 10 11
NPVwas 86 1 - abI e 2 s hovvs t he PPV an d NPVvaI u es

r abIe 1 Sens i t I Vi t y and s peci f i ci t y Of CT s ca n ManV s t udi es have s t at ed t hat C T pI ays a c r t i ca I

Or ga ns Sens i t iv ( ) Speci f i ci t y( ) r 0 I e i n t he i den t f i cat i On 0f s u s pe ct e d bOwe I a nd me-

s ent e r ic i ni u r ies It i s wor t hy t o not e t hat t he ac cur ac y

0f t hi s me t hod i n di agnos i ng t he Ver y I nj u r e s ha s been

ques t j one d 12 on t he c ont r a t he pr es ent s t udy dOcU

ment ed CT s ca n t O be mOr e s ens i ve f or ve r ki dney

a nd s pI een i ni u r es Ac c or di ng t o t he s e r e su I t s t hi s

di a gnOs t i c met hOd ha s a 10w se nSi t i vi t y i n pat i ent s wi t h

panc r eas mes ent er y a nd coI on i nj ur y I n a s t udy pe

f o r me d i n 20 03 i t was a Is O s hown t ha t 1 3 0f pat i e nt s

wi t h per f or a t ed s ma boweI i ni u had a nor r Tl aI C T s ca n

pr eope r at j veI y 1 3

Ot her s ha e doc ume nt ed CT as t he r e fe r e nc e t ec h-

ni que f or i de nt i f i cat i on 0f r e t r oper I t onea I he ma t Oma an d

ki dney i nj u r es 14 Si m ar I y t h e pr es ent s t udy s uppo r t ed

t he ab Ove- ment i one d r eSUlt s

Mo 0ver ma ny sea r cher s beI i e ve t ha t CT s ca n

c ouI d be r es er ved f or pat j ent S wi t h negat i ve f i ndi ngs On

sonogr a phy an d c n i cal s us pi ci ous of i ni u Manco et

aI i n t he i r s t udy have r eport ed a n aCcep t abI e accu -

r a cy f or f I ui d an d I i ver sp I eni c an d r e na I i ni u r es i n pa

t i ent s wi t h ma i or t r aum
a I n ot he r wor ds t hey s t at ed

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t ha t CT ha d a hi gh di agnos t i c ac cur ac y f o r s i ngIe I e- ma J I r auma 1995 39( 2) 325 330
s i ons i n bot h mai or an d mi n or t r auma They s ug ges t ed 5 Bmwn CKDu KA Wi l s on K Di a gno st i c eval ua l j on 0f

t ha t t he f a I s e negat i ve nepOr t s i n t he i r s t udy r epr esent ed pat i ent s wi mbl unt a bdomi na l t muma a de ci s i on a l ysi s Aca d
I a Ck Of det a Of whOI e body pr Ot oc Ol s an d ar t f act s du e Enl e Med 2000 7( 4) 385 396

t O pa t i e nt s c Ondi t i on On t he c ont r a r y Li vI ngs t on et 6 Bl ow O Bas s D Bu e r K ct a1 SPeed a nd ef ci ency i n

a115 be| j e ve t ha t pa e nt S wi t h s us pect ed ab domi na I i n- me r es us ci t at i on of bl unt t r auma pat i ent s wi mmu l t i pl e injurie s

i ur y s houI d be ob s er v ed i n hospi t aI f o r at I e as t 24 hour s le adV ge of di a gnos pe r i t one al l ava ge oVer a_bdo mi nal com

e ven when t her e i s no s i gns of i ni uwi n CT s ca ns pu t eI i zed t omogr aphy J Tr auma 1 998 44( 2) 287 290

7 Rad wan MM Abu Zi dan FM Fo cus ed a ss e s sme nt

I t couI d be cOn Cl ud ed t ha t c ompa r ed wI t h di agn0S- sono h t rauma(f ' ASD a nd CT s can i I l bl un t abdomj na l t ma
t jc met hOds s uc h as uIt r a sOnOgr a phy C T s ca n i s es - su con s pcr s pect i Ve A Heal t h Sci 200| 6 6(3) 187 190

pe c i a l l VuSe f uI f o r sOI i d Or Qans On t he Ot he r ha nd j t is 8 Ot i mo Y Henmi H Ma s hi ko K et a 1 New di a gnos t i c

not an i nva s i ve met hOd C0mpa d W

i t h DP L I n r egar d pe dt on eal l ava ge cri a f br di a gnos i s of i nt est i ll i nj ury J Tmum
wi t h t he hi gh s peci fi c 0f CT I mage s i n t he abse nc e of 1998 44( 6) 99l 999

i ni urv no I a par o t omy j s r equi r ed when t he C T s c an 9 W

i nt eml a rk M Mouhs i ne E Theum n N e t a1 Thor a

i mage s ar e r epOrt ed t 0 be nOr ma | c ol umbar s pi n e f }act ur es i n pat i ent s wh o ha ve s us t ai ned t rauma

d i ct i on wi mmul t i det ect or mwCT Ra di ol ogy 2003 227( 3)

The f i ndi ngs 0f t he pr eSent st udy vea I t ha t CT s ca n 681 689

c an be cOns i der ed as a gOod chOi ce e spec i a y f Or pa- 10 Val ent i n o M Ser r a C Zi r oni G et a1 B1un t a bdomi na l

ent s wi t h bI unt ab domi na I t r auma i n t eachi ng ho spi t r a uma e me ency co nt r as t - enh an ced s onogr hy f or det ect i on

t aI s whe r e t he r adi Ol Ogi c a cade mi c st a j S not pr es ent of s ol i do ur i es A AmJ R( ) en eno l 200 6 186( 5) 1361 -
i n t he hospi t a I i n t he ni ght s hi f t s Manv bel i e ve t ha t t he 1367

S0nOgr a phy per l br med du r I ng t heSe hOur s I a c k t he a c 11 M

ar coGG Di e goS Gi ul i oA e t a 1 Sc re e ni ngUS dCT

cept abI e aCCur a cy bec ause i t i s nOt pe r f Or me d by an f or bl unt a bdomi na l t r auma a re s pec t i ve st ud y Eu r J Ra di o l

exper t r adi Ol Ogi st USi na C T s can t he r es j dent s ar e 2005 56( 1) 97 101

a bI e t o ha ve t he i ma ges w t h an accep t abI e se nsi t i vi t y 12 Br of man N At r i M Hans on J M e t a1 Eval uat i on of

a nd spec i f j cj t y t o r e por t t he ab domi naI i ni u r i es bowel a nd mese nt er i c bl unt t r a uma wi t h mu l t i d et e ct or CT

Radi ogr al ) h i cs 2006 26 ( 4) 11 19 1131

AcknowI edgment The au t h Or s Of t hi s a rt i cl e ar e i nd ebt ed 13 Fakh r y SM Wat t s DD Luc het t e FA et a1 Cur r en t di ag

t O t he Res e ar ch a nd De Ve I Opme nt Ce nt er Of Si n a HOs pi t al f Or i t s nos t i c a ppma c he s l a ck s ens i t i Vi t y i n t he di agno si s of per f o r at ed

cOODer at i On bl unt sma l l bowel i nj ur y anal ysi s f m 27 5 55 7 t ra uma admi s

s i on s f r om t I l e EAST mum i I l s t i tut i onal H t r i al J Tr auma 2003

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I nj ur y 1996 27( 2) 117 124

4 Boul ge r BR Br e I memaI l FD Mckl l BA et a1 A p Rece | ved Augus t 25 2008)

spe ct i Ve st udy of e me r ge nt abdoI I l i n al s onogr a phy af t er bl unt Edi t e d by SONGShuang - mi ng

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