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- Title
Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study.
- Authors
Saksobhavivat, Nitima; Shanmuganathan, Kathirkamanathan; Boscak, Alexis; Sliker, Clint; Stein, Deborah; Bodanapally, Uttam; Archer-Arroyo, Krystal; Miller, Lisa; Fleiter, Thorsten; Alexander, Melvin; Mirvis, Stuart; Scalea, Thomas; Boscak, Alexis R; Sliker, Clint W; Stein, Deborah M; Bodanapally, Uttam K; Miller, Lisa A; Fleiter, Thorsten R; Alexander, Melvin T; Mirvis, Stuart E
- Abstract
<bold>Purpose: </bold>Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined.<bold>Materials and Methods: </bold>This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation. The primary outcome measures were operative findings and clinical follow-up. CT results were compared with the primary outcome measures.<bold>Results: </bold>Of one hundred and seventy-one patients (72 gunshot wounds, 99 stab wounds; age range, 18-57 years; median age, 28 years) with penetrating torso trauma who underwent CT, 45 % were followed by an operation and 55 % by clinical follow up. Thirty-five patients had a gastrointestinal injury at surgery. The sensitivity, specificity, and accuracy of CT for diagnosing a gastrointestinal injury for all patients were each 91 %, and for predicting the need for surgery, they were 94 %, 93 %, 93 %, respectively. Among the 3 % of patients who failed observation, 1 % had a gastrointestinal injury.<bold>Conclusion: </bold>CT is a useful technique to diagnose gastrointestinal injury following penetrating torso injury. CT can help discriminate patients requiring observation or surgery.<bold>Key Points: </bold>• The most sensitive sign is wound tract extending up to gastrointestinal wall. • The most accurate sign is gastrointestinal wall thickening. • Triple-contrast CT is a useful technique to diagnose gastrointestinal injury. • Triple-contrast CT helps to discriminate patients requiring observation and surgery.
- Subjects
COMPUTED tomography; GASTROINTESTINAL surgery; GASTROINTESTINAL diseases; TORSO; TOMOGRAPHY; WOUNDS &; injuries; GASTROINTESTINAL system injuries; CHEST injuries; ABDOMINAL injuries; GUNSHOT wounds; LONGITUDINAL method; PHYSICAL diagnosis; STAB wounds; WEIGHTS &; measures; CONTRAST media; MULTIDETECTOR computed tomography; DIAGNOSIS
- Publication
European Radiology, 2016, Vol 26, Issue 11, p4107
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-016-4260-3