Use of Oral Contrast for Abdominal Computed Tomography in Children With Blunt Torso Trauma

被引：5

作者：

Ellison, Angela M. ^{[1
]}

Quayle, Kimberly S. ^{[2
]}

Bonsu, Bema ^{[3
]}

Garcia, Madelyn ^{[4
]}

Blumberg, Stephen ^{[5
]}

Rogers, Alexander ^{[6
]}

Wootton-Gorges, Sandra L. ^{[7
]}

Kerrey, Benjamin T. ^{[10
]}

Cook, Lawrence J. ^{[11
,12
]}

Cooper, Arthur ^{[13
]}

Kuppermann, Nathan ^{[8
,9
]}

Holmes, James F. ^{[8
]}

机构：

[1] Childrens Hosp Philadelphia, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA

[2] Washington Univ, Dept Pediat, St Louis Childrens Hosp, St Louis, MO 63130 USA

[3] Univ Rochester, Dept Pediat, Rady Childrens Hosp, Rochester, NY USA

[4] Univ Rochester, Dept Emergency Med, Rochester, NY USA

[5] Albert Einstein Coll Med, Dept Pediat, Bronx, NY 10467 USA

[6] Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USA

[7] Univ Calif Davis, Sch Med, Dept Radiol, Sacramento, CA 95817 USA

[8] Univ Calif Davis, Sch Med, Dept Emergency Med, Sacramento, CA 95817 USA

[9] Univ Calif Davis, Sch Med, Dept Pediat, Sacramento, CA 95817 USA

[10] Cincinnati Childrens Hosp Med Ctr, Div Emergency Med, Cincinnati, OH 45229 USA

[11] Univ Utah, Dept Pediat, Salt Lake City, UT USA

[12] PECARN Data Coordinating Ctr, Salt Lake City, UT USA

[13] Columbia Univ Coll Phys & Surg, Dept Surg, New York, NY 10032 USA

来源：

ANNALS OF EMERGENCY MEDICINE | 2015年 / 66卷 / 02期

关键词：

MESENTERIC INJURIES; BOWEL; PERFORMANCE; DIAGNOSIS; CT;

D O I：

10.1016/j.annemergmed.2015.01.014

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries. Methods: This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency department with abdominal CT using intravenous contrast were eligible. Oral contrast use was based on the participating centers' guidelines and discretions. Clinical courses were followed to identify patients with intra-abdominal injuries. Abdominal CTs were considered positive for intra-abdominal injury if a specific intra-abdominal injury was identified and considered abnormal if any findings suggestive of intra-abdominal injury were identified on the CT. Results: A total of 12,044 patients were enrolled, with 5,276 undergoing abdominal CT with intravenous contrast. Of the 4,987 CTs (95%) with documented use or nonuse of oral contrast, 1,010 (20%) were with and 3,977 (80%) were without oral contrast; 686 patients (14%) had intra-abdominal injuries, including 127 CTs (19%) with and 559 (81%) without oral contrast. The sensitivity in the detection of any intra-abdominal injury in the oral contrast versus no oral contrast groups was sensitivity(contrast) 99.2% (95% confidence interval [CI) 95.7% to 100.0%) versus sensitivity(no contrast) 97.7% (95% CI 96.1% to 98.8%), difference 1.5% (95% CI -0.4% to 3.5%). The specificity of the oral contrast versus no oral contrast groups was specificity(contrast) 84.7% (95% CI 82.2% to 87.0%) versus specificity(no contrast) 80.8% (95% CI 79.4% to 82.1%), difference 4.0% (95% CI 1.3% to 6.7%). Conclusion: Oral contrast is still used in a substantial portion of children undergoing abdominal CT after blunt torso trauma. With the exception of a slightly better specificity, test characteristics for detecting intra-abdominal injury were similar between CT with and without oral contrast.

引用

页码：107 / 115

页数：9

共 19 条

[1] Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma [J].

Allen, TL ;

Mueller, MT ;

Bonk, RT ;

Harker, CP ;

Duffy, OH ;

Stevens, MH .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2004, 56 (02) :314-322

[2] Blunt bowel and mesenteric injury: Diagnostic performance of CT signs [J].

Breen, DJ ;

Janzen, DL ;

Zwirewich, CV ;

Nagy, AG .

JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 1997, 21 (05) :706-712

[3] ORAL CONTRAST IS NOT NECESSARY IN THE EVALUATION OF BLUNT ABDOMINAL-TRAUMA BY COMPUTED-TOMOGRAPHY [J].

CLANCY, TV ;

RAGOZZINO, MW ;

RAMSHAW, D ;

CHURCHILL, MP ;

COVINGTON, DL ;

MAXWELL, JG .

AMERICAN JOURNAL OF SURGERY, 1993, 166 (06) :680-685

[4] COMPUTED-TOMOGRAPHY IN THE DIAGNOSIS OF BLUNT INTESTINAL AND MESENTERIC INJURIES [J].

DONOHUE, JH ;

FEDERLE, MP ;

GRIFFITHS, BG ;

TRUNKEY, DD .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1987, 27 (01) :11-17

[5] Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries [J].

Holmes, James F. ;

Lillis, Kathleen ;

Monroe, David ;

Borgialli, Dominic ;

Kerrey, Benjamin T. ;

Mahajan, Prashant ;

Adelgais, Kathleen ;

Ellison, Angela M. ;

Yen, Kenneth ;

Atabaki, Shireen ;

Menaker, Jay ;

Bonsu, Bema ;

Quayle, Kimberly S. ;

Garcia, Madelyn ;

Rogers, Alexander ;

Blumberg, Stephen ;

Lee, Lois ;

Tunik, Michael ;

Kooistra, Joshua ;

Kwok, Maria ;

Cook, Lawrence J. ;

Dean, J. Michael ;

Sokolove, Peter E. ;

Wisner, David H. ;

Ehrlich, Peter ;

Cooper, Arthur ;

Dayan, Peter S. ;

Wootton-Gorges, Sandra ;

Kuppermann, Nathan .

ANNALS OF EMERGENCY MEDICINE, 2013, 62 (02) :107-116

[6] Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries [J].

Holmes, JF ;

Offerman, SR ;

Chang, CH ;

Randel, BE ;

Hahn, DD ;

Frankovsky, MJ ;

Wisner, DH .

ANNALS OF EMERGENCY MEDICINE, 2004, 43 (01) :120-128

[7] Identification of children with intra-abdominal injuries after blunt trauma [J].

Holmes, JF ;

Sokolove, PE ;

Brant, WE ;

Palchak, MJ ;

Vance, CW ;

Owings, JT ;

Kuppermann, N .

ANNALS OF EMERGENCY MEDICINE, 2002, 39 (05) :500-509

[8] Helical computed tomography of bowel and mesenteric injuries [J].

Killeen, KL ;

Shanmuganathan, K ;

Poletti, PA ;

Cooper, C ;

Mirvis, SE .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2001, 51 (01) :26-36

[9] Blunt bowel and mesenteric injuries: The role of screening computed tomography [J].

Malhotra, AK ;

Fabian, TC ;

Katsis, SB ;

Gavant, ML ;

Croce, MA .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2000, 48 (06) :991-998

[10] RUPTURE OF THE BOWEL AFTER BLUNT ABDOMINAL-TRAUMA - DIAGNOSIS WITH CT [J].

MIRVIS, SE ;

GENS, DR ;

SHANMUGANATHAN, K .

AMERICAN JOURNAL OF ROENTGENOLOGY, 1992, 159 (06) :1217-1221

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