Utilization of a clinical prediction rule for abdominal–pelvic CT scans in patients with blunt abdominal trauma

Michael T Corwin, Lucas Sheen, Alan Kuramoto, Ramit Lamba, Sudharshan Parthasarathy, James F Holmes Jr

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

This study aims to determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. A retrospective review of adult patients with blunt abdominal trauma undergoing abdominal CT scans was performed. The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 %; or pneumothorax or rib fracture on chest X-ray. The CP rule was negative if all variables were negative. Acute intervention was defined as therapeutic laparotomy or angiographic embolization. All variables in the CP rule were obtained in 218/262 (83 %; 95 % confidence interval (CI), 78, 88 %) patients. Of the 44 patients without complete CP rule assessment, 1 (2.3 %; 95 % CI, 0.1 %, 12.0 %) had an IAI but did not undergo therapeutic intervention. IAI was present in 11 (6.7 %; 95 % CI, 3.4, 11.6 %) of the 165 patients with at least one CP rule positive and 4 (36 %; 95 % CI, 11, 69 %) underwent therapeutic intervention. In the CP rule-negative patients, IAI was identified in 1/53 (1.9 %; 95 % CI, 0, 10.1 %) and no therapeutic intervention was required. An important percentage of patients undergoing abdominal CT are not assessed for or have a negative CP rule. Improved implementation of this CP rule may reduce unnecessary abdominal CT scans in patients presenting with blunt abdominal trauma.

Original languageEnglish (US)
Pages (from-to)571-576
Number of pages6
JournalEmergency Radiology
Volume21
Issue number6
DOIs
StatePublished - Nov 9 2014

Fingerprint

Decision Support Techniques
Tomography
Abdominal Injuries
Wounds and Injuries
Confidence Intervals
Rib Fractures
Blood Pressure
Glasgow Coma Scale
Pneumothorax
Therapeutics
Hematocrit
Femur
Laparotomy
Thorax
Erythrocytes
X-Rays

Keywords

  • Abdominal trauma
  • Clinical predictors
  • CT
  • Utilization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Emergency Medicine

Cite this

Utilization of a clinical prediction rule for abdominal–pelvic CT scans in patients with blunt abdominal trauma. / Corwin, Michael T; Sheen, Lucas; Kuramoto, Alan; Lamba, Ramit; Parthasarathy, Sudharshan; Holmes Jr, James F.

In: Emergency Radiology, Vol. 21, No. 6, 09.11.2014, p. 571-576.

Research output: Contribution to journalArticle

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abstract = "This study aims to determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. A retrospective review of adult patients with blunt abdominal trauma undergoing abdominal CT scans was performed. The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 {\%}; or pneumothorax or rib fracture on chest X-ray. The CP rule was negative if all variables were negative. Acute intervention was defined as therapeutic laparotomy or angiographic embolization. All variables in the CP rule were obtained in 218/262 (83 {\%}; 95 {\%} confidence interval (CI), 78, 88 {\%}) patients. Of the 44 patients without complete CP rule assessment, 1 (2.3 {\%}; 95 {\%} CI, 0.1 {\%}, 12.0 {\%}) had an IAI but did not undergo therapeutic intervention. IAI was present in 11 (6.7 {\%}; 95 {\%} CI, 3.4, 11.6 {\%}) of the 165 patients with at least one CP rule positive and 4 (36 {\%}; 95 {\%} CI, 11, 69 {\%}) underwent therapeutic intervention. In the CP rule-negative patients, IAI was identified in 1/53 (1.9 {\%}; 95 {\%} CI, 0, 10.1 {\%}) and no therapeutic intervention was required. An important percentage of patients undergoing abdominal CT are not assessed for or have a negative CP rule. Improved implementation of this CP rule may reduce unnecessary abdominal CT scans in patients presenting with blunt abdominal trauma.",
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