SELECTIVE NON-OPERATIVE MANAGEMENT OF BLUNT ABDOMINAL TRAUMA USING COMPUTED TOMOGRAPHY

Abstract

OBJECTIVE: To determine the accuracy of computed tomography (CT) scan in the evaluation and grading of the severity of blunt abdominal organ injury for the purpose of selecting patients who can be managed conservatively. To compare the CT grading system (using organ injury scaling of the American Association for Surgery of Trauma: AAST) with the trauma score : abbreviated injury score and injury severity score (AIS, ISS) and clinical outcome in patients who were treated by conservative and surgical management.

MATERIALS AND METHODS: Twenty-two patients suspected of intraabdominal organ injury who underwent complete CT scan study from January 1994 to October 1999 were analyzed and graded according to organ injury scale (OIS) grading system (Table 1-7). The clinical records of these patients were reviewed and correlated with the CT grading system, trauma score and clinical outcome.

RESULTS: Seven patients had liver injury, four of them (58%) received conservative treatment, mean OIS=II, mean ISS=12.25. Three patients (42%) were treated by surgery, mean OIS=III, and ISS=30. One of them was operated due to jejunal perforation that was missed on initial CT scan. Four patients had splenic injury, | case (25%) had successful conservative treatment, OIS=II, ISS=9, and 3 cases (75%) underwent surgery, OIS ranged from III-IV, ISS=21.3. Three patients had pancreatic injury, 2 in the three patients (67%) had conservative treatment, OIS range II-III, ISS=9, and in the remaining one patient (33%) underwent surgery due to duodenal perforation that was missed on CT scan, OIS=II, ISS=10.Two patients in renal injury group, mean OIS ranged from I-III, ISS=7.5, had successful conservative treatment. One patient who had bladder injury, OIS=IV, ISS=21 underwent surgical management without complication. One patient with clinical suspicion of renal injury had only abdominal wall hematoma, ISS=9. Two cases were negative CT scan, had very low ISS (ISS=1). One patient with retroperitoneal hematoma received percutaneous drainage with good result.

CONCLUSION: CT scan is the investigation of choice, having high accuracy in the diagnosis and grading of the severity of blunt abdominal trauma particularly in solid organ injury. There are difference of trauma score (OIS, ISS) between patients who underwent conservative and surgical management that can be used for prediction and evaluation in the selection of non-operative management of blunt abdominal trauma.

AIS = Abbreviated Injury Score, ISS = Injury Severity Score, OIS = Organ Injury Scale