Asymptomatic blunt trauma patients over age 14 with a negative CT abdomen/pelvis (CTAP) did not have delayed missed injuries.
Why does this matter?
Missed blunt traumatic injuries may be potentially dangerous to patients, especially if they are admitted to another non-trauma service or discharged home. But this study seems to raise more questions than it answers.
So…just scan all asymptomatic patients?
This was a prospective study of patients at a level 1 trauma center who had CTAP. 806 were able to be evaluated. 59.4% (479/806) of these were asymptomatic, defined as no pain, external signs of trauma, and no tenderness. Of these, 13.6% (65/479) had injuries identified on CT, 11 of which were serious solid organ injuries, 3 of which required surgery. There are a couple issues with this study. First of all, the only patients included were those in which the decision to obtain CTAP had already been made, which means someone must have had suspicion of injury. Also, how adequate was the assessment of tenderness in these patients with GCS 15, yet over 13% had intra-abdominal injuries? Are we to believe these patients with shattered solid organs had no pain and no tenderness…really? Not that I have never seen this, but generally this doesn’t square with my experience and with common sense. Regardless, they all got scanned. And the point of this study was that those who were scanned did not need a prolonged period of observation for injuries missed on CT but were clear to go to another service…aka Trauma says, “Not it!”
Negative CT can Safely Rule out Clinically Significant Intra-abdominal Injury in the Asymptomatic Patient After Blunt Trauma: Prospective Evaluation of 1193 Patients. J Trauma Acute Care Surg. 2017 Sep 20. doi: 10.1097/TA.0000000000001705. [Epub ahead of print]
Peer reviewed by Thomas Davis, MD.