Usefulness of Multidetector Computed Tomography(M DCT) for the Initial Evaluation of Multiple Blunt Trauma of the Trunk

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Background: Focused assessment with sonography for trauma (FAST) is useful for detecting hemoperitoneum (HE) in trauma patients in the emergency room (ER), but, patients’condition cannot be evaluated adequately by FAST alone. CT is useful for the diagnosis of multiple trauma, but has certain drawbacks. We evaluated the utility of mutidetector computed tomography(MDCT) as the initial tool for proper diagnosis and treatment planning of multiple trauma patients. Method: We retrospectively analyzed 128 cases treated in ER of Gunma University Hospital between April 1, 2005 and December 31, 2006, and they were hospital patients were hospitalized with blunt multiple trauma. We analyzed the sensitivity, specificity, and accuracy of FAST, compiled MDCT finding, lifesaving treatment, and outcome. Result: Eight patients were FAST positive, and 7 of the 8 were scanned by MDCT. There were 120 patients were FAST negative patients, 23 of the 120 were MDCT-negative, despite visceral injury, however 9 of the 120 had visceral injury by MDCT findings. Damage control surgery without MDCT was performed in one case, but the patient died after surgery. Six of the patients in the HE-positive group had really HE. One of the 6 died while a waiting surgery, transcatheter arterial embolization (TAE) was performed in three patients, and one person out of the 3 died. The course of the remaining 2 patients was monitored, and they are alive. A patient in the HE-negative group with bladder rupture required surgery. There were 120 patients in the FAST-negative group. One of the 6 patients in the HE-positive subgroup died while a waiting surgery. One patient required chest and pericardial drainage. TAE was performed in 2 patients, and the remaining 6 were monitored and are alive. There were 23 FAST-negative patients patients who had visceral injury. Five of them required chest drainage, one received TAE, 17 were monitored, and all of the 23 are alive. There were 14 cases of pelvic fracture alone, and all of them were FAST-negative. One patient required surgery for open femoral fracture, TAE was performed in three, 10 monitored, all 14 are alive. Only one patient developed shock during MDCT. The others underwent scanning safely. Conclusion: MDCT is a better tool for the diagnosis of blunt multiple trauma of the trunk than CT, because the scanning timeis shorter.
北関東医学会の論文
2008-05-01

Usefulness of Multidetector Computed Tomography(M DCT) for the Initial Evaluation of Multiple Blunt Trauma of the Trunk

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