Jean-Matthieu Perrin (Marseille / FR), Tristan Monchal (Toulon / FR), Laure Salou-Regis (Marseille / FR), Ghislain Pauleau (Marseille / FR), Paul Balandraud (Toulon / FR), Yvain Goudard (Marseille / FR)
Abstract text (incl. references and figure legends)
Objective: The management of penetrating abdominal trauma has greatly benefited from the development of computed tomography (CT-scan), particularly in stable patients (1,2). The aim of our study is to evaluate the overall diagnostic accuracy of preoperative CT for penetrating abdominal injuries.
Material and methods: Between January 1, 2015, and January 1, 2022, 81 patients were hospitalized with penetrating abdominal trauma at the Sainte-Anne and Laveran Teaching Military Hospitals. Fifty-one stable patients managed with abdomino-pelvic CT-scan and abdominal surgery were included. Radiological and surgical data were collected on the computerized record and compared by descriptive analysis (sensitivity, specificity, positive and negative predictive value) and by evaluation of the CT-scan and surgical concordance using the Kripendorff alpha coefficient.
Results: The cohort consisted mainly of men (n=45; 88%), 32 (62.7%) had stab wounds and 18 (35.3%) gunshot injuries. The median age was 36 years [25-47]. The median index of Injusry Severity Score (ISS) was 17 [10-26]. Excellent agreement was obtained for solid organs (⍺=0.801) with high sensitivity and specificity (81.8% and 96.6% respectively). The greatest discrepancies were obtained for hollow viscus injuries (⍺=0.262, sensitivity 53.3% and specificity 76.2%) and the diaphragm (⍺=0.673, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for 5 patients (9.8%). The failure rate of non-operative treatment was 10% (n=1).
Conclusions: CT-scan detection of solid organ injuries in patients with penetrating abdominal injury is excellent. However, the detection of hollow viscus and diaphragm injuries remains a challenge with a risk of over- and under-diagnosis. Laparoscopic exploration should be able to supplement the shortcomings of CT.
References :
1. Goodman CS. Am J Roentgenol. 2009;193(2):432‑7.
2. Sander A et al. Eur J Trauma Emerg Sur 2022;48(2):881‑9.
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