Written by Vivian Lei
Spoon Feed
In patients presenting with an abdominal gunshot wound with clear indications for operative intervention, a preoperative CT provides no additional benefit and frequently misses injuries.
Go straight to OR. Do not pass CT. Do not collect unnecessary imaging.
This was a retrospective review of 149 trauma patients over a 6 year period who sustained an abdominal GSW (AGSW) and underwent laparotomy. The researchers analyzed data to determine concordance between abdominopelvic CT (CTAP) and operative findings. Of the patients included in the study, 72.5% had a clear indication for laparotomy. Clear indications for laparotomy included hypotension (SBP <90 mm Hg), presence of abdominal pain and/or peritonitis, and/or evisceration. CTAP and intraoperative findings were concordant in 57% of cases. CTAP missed injuries in 36.2% of patients which were subsequently found in the OR. Additionally, findings on CTAP resulted in 3 patients undergoing a trial of nonoperative management who ultimately underwent laparotomy, 3 patients who underwent diagnostic angiograms without therapeutic intervention, and 6 patients who underwent laparotomy with negative intraoperative findings. Limitations of the study include its retrospective nature, absence of comparison with nonoperative CTAP candidates, and being conducted at a single institution.
How will this change my practice?
In a patient with an AGSW who need to go to the OR, obtaining CT imaging delays definitive care, increases costs, and leads to poor patient outcomes. Based on this study, CTAP is a poor roadmap for patients undergoing laparotomy due to the rate of missed injuries. This study from the trauma surgery literature may aid in discussions with our surgical colleagues in advocating for the most appropriate care for critical trauma patients with AGSWs.
Source
The fallacy of a roadmap computed tomography after an abdominal gunshot wound: A road that leads to nowhere. J Trauma Acute Care Surg. 2024 Nov 1;97(5):785-790. doi: 10.1097/TA.0000000000004404. Epub 2024 May 28. PMID: 39443840
