Is Triple Contrast Computed Tomographic Scanning Useful in the Selective Management of Stab Wounds to the Back?

McAllister, Earl W.; Pérez, M. García; Albrink, Michael; Olsen, S; Rosemurgy, Alexander S.

doi:10.1097/00005373-199409000-00011

Cited by 20 publications

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“…We are concerned with hemodynamically stable patients with nonsuperficial injuries (wounds that penetrate the posterior muscular fascia) who present without signs of peritonitis. The prevalence of injury requiring surgical intervention in this subset is rather low [8.1% in our study, 1.8% in the series by Phillips et al (5), and 3.8% in the study by McCallister et al (6)]. If critical injuries do occur, however, they can be difficult to assess, since retroperitoneal injuries are notorious for being clinically inapparent.…”

Section: Discussioncontrasting

confidence: 49%

“…Prior studies also demonstrate a sensitivity of nearly 100% for surgically significant injury (5,6). We believe that CT should be part of the routine management of these patients.…”

Section: Discussionmentioning

confidence: 74%

“…The authors maintained that the CT results rarely altered clinical care and that selective management of this group without CT would not have failed to detect surgically significant injuries. They concluded that CT is not cost effective and did not recommend its routine use in these patients (6).…”

mentioning

confidence: 99%

“…Indeed, the debate has almost come full circle. McCallister et al (6), in the most recently published study of the subject, reported on 53 patients with stab wounds evaluated withTCCT. The authors maintained that the CT results rarely altered clinical care and that selective management of this group without CT would not have failed to detect surgically significant injuries.…”

mentioning

confidence: 99%

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Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank

Maldjian

Zurlo

Sebastiano

1997

Emergency Radiology

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The purpose of this study was to examine the role of abdominal computed tomography (CT) in the evaluation and management of stab wounds to the back and flank. We retrospectively studied 62 patients with nonsuperficial stab wounds to the back and flank who presented without signs of peritonitis or hemodynamic instability. Twenty-seven patients had conventional CT with oral and intravenous contrast medium administration. Twenty.seven patients had CT with oral, intravenous, and rectal contrast medium, which is called "triple contrast CT" (TCCT). Eight patients had CT with oral and intravenous contrast medium with the addition of air insufflated rectally. Patients with no CT evidence of intra-abdominal injury or with evidence of visceral injury that was considered minor were initially treated with observation. Patients with CT evidence of surgically significant injury received immediate celiotomy. The results of laparotomy and~or patient follow.up were used to determine the sensitivity and specificity of CT for classification of patients into operative or nonoperative categories. American Society of Emergency Radiology 9 1997For proper classification of patients into operative or nonoperative categories, conventional CT and CT with rectal contrast demonstrated nearly identical sensitivities of 100%, specificities of 96 %, and accuracies of 96 %. The results were similar for the group that received rectal air. Combining all patients, CT demonstrated a sensitivity of 100%, a specificity of 96 %, and an accuracy of 97%. The negative predictive value was 1 O0 %, and only 2 of the 62 patients (3.2 %) received nontherapeutic laparotomies. CT is useful in the routine management of hemo. dynamically stable patients with nonsuperficial stab wounds to the back and flank.

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Section: Discussioncontrasting

confidence: 49%

“…Prior studies also demonstrate a sensitivity of nearly 100% for surgically significant injury (5,6). We believe that CT should be part of the routine management of these patients.…”

Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank

Maldjian

Zurlo

Sebastiano

1997

Emergency Radiology

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“…Triple-contrast CT (oral, intravenous, and rectal) has been used with excellent results to evaluate the retroperitoneum after flank and back stab wounds. [4][5][6] Computed tomography has also been used to determine bullet trajectory after abdominal gunshot wounds with encouraging results. [7][8][9][10] The role of CT in evaluating patients with AASWs remains unknown.…”

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confidence: 99%

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Salim¹

2006

Arch Surg

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Setting: Academic level I trauma center.Patients and Methods: All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.Main Outcome Measures: Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).Results: One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%. Conclusions:In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.

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Abdominal Trauma

Mackersie¹

Essential Practice of Surgery

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Is Triple Contrast Computed Tomographic Scanning Useful in the Selective Management of Stab Wounds to the Back?

Cited by 20 publications

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Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank

Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Abdominal Trauma

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