AbstractBackground: Trauma is the leading cause of death in persons under 45 years of age, with 10% of these fatalities attributable to abdominal injury. Indian statistics reveal disproportionate involvement of younger age groups (15-25 yrs) with fatality rates 20 times more than that for developed countries
[1] and preventable deaths ranging about 30%. The swift recognition of life-threatening injuries and rapid commencement of appropriate treatment increases the chances of survival in these patients. CT is the diagnostic tool of choice for the evaluation of abdominal injury due to blunt trauma in hemodynamically stable patients
[2]. The present study was conductedto assess the role of computed tomography as a primary diagnostic modality in the evaluation of blunt abdominal injury in hemodynamically stable patients and to determine the choice of management by grading the visceral injuries using AAST classification. The study also compared intra operative findings with CT findings to assess the sensitivity and specificity of CT scan as a gold standard modality in blunt trauma.
Materials and methods: CECT abdomen and pelvis were performed in 190 cases of blunt abdominal injury admitted in trauma ward in a busy tertiary medical centre based on the clinical suspicion ofintra abdominal injury.
Results: The sensitivity and specificity for predicting visceral and bowel injuries by CT are 100%, 98% compared to 84.9%,98.06% seen in EFAST. Based on the CT findings,74% of the patients were managed conservatively and only 26% were taken up for surgery. All the patients with bowel injury and grade 5 visceral injury were taken up for surgery. Grade 3 and 4 patients in the studywere managed either conservatively or surgically depending upon the hemodynamic status and other associated injuries.
Conclusion: CT is highly sensitive, specific and accurate in detecting the presence or absence of visceral injury and defining its extent compared to EFAST. CT grading of organ injuries is helpful in deciding management (Operative vs Conservative), thus improving mortality in severe injuries and helps in avoiding unnecessary exploration, thereby decreasing the morbidity of unnecessary surgery in present era.
