Society of Black Academic SurgeonsDiagnosing blunt hollow viscus injury: is computed tomography the answer?
Section snippets
Methods
Hartford Hospital is an 800-bed, level 1 tertiary care center in central Connecticut serving a catchment area that includes northern and central Connecticut as well as eastern New York, parts of southern Massachusetts, and southwestern Rhode Island. After obtaining institutional review board approval, we retrospectively reviewed the medical records of patients identified from the trauma registry aged ≥18 years admitted for blunt trauma from January 2009 through December 2011. We then extracted
Results
During the study period, 2,912 patients were admitted after sustaining blunt trauma. Of these, 340 (12%) sustained BAT, and 30 (9%) patients from that group had BHVIs. Of the 340 patients reviewed, 1 died, and all but 2 patients with BHVIs were evaluated using CT, providing 337 evaluable computed tomographic reports. One of the 2 patients presented with hypotension, had positive results on focused abdominal sonography for trauma, and was taken directly to the operating room, where injury to the
Comments
Our retrospective review revealed a 9.0% incidence of BHVI in patients admitted with BAT. This series is, to our knowledge, the largest single-center series of BHVI reported. It is important to differentiate the incidence of BHVI in all blunt trauma admissions (1.0%) from those with BAT. The group of patients admitted after blunt trauma is extremely heterogeneous and includes patients with nonabdominal trauma who are not at risk for BHVI. Moreover, we found that not surprisingly, CT had higher
Conclusions
The results of this study identify unexpected findings: patients in whom BHVIs were missed on CT all had evidence of bladder injuries. Although the finding of bladder injury was not a significant predictor of risk for BHVI, the overall sample size was small given the low frequency with which BHVI is identified. The present study cannot confirm or refute the presence of bladder injury as a marker for BHVI, but it is interesting that 27% of patients with BAT and bladder injuries had concomitant
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The authors declare no conflicts of interest.