Computed tomography for evaluating blunt abdominal trauma in the low-volume nondesignated trauma center: The procedure of choice?

Background: Scepticism has been expressed regarding the accuracy of computed tomography for evaluating patients with blunt abdominal trauma in low-volume institutions. Diagnostic peritoneal lavage has been suggested as a more reliable method, and recently ultrasound has been proposed as a quick alternative. We sought to determine the accuracy of computed tomography at our low-volume center, which lacks 24-hour, in-house computed tomography dedicated radiologists. Methods: A prospective case series of patients who had computed tomographic evaluation requested for suspected blunt abdominal trauma were enrolled over a 1-year study period. Results: Fifty-five patients were enrolled, Injuries were identified in 12 patients, six of whom required intervention. The diagnostic accuracies for the detection of injury were 86% and 90.5% for radiology residents and attending radiologists, respectively, The likelihood ratios for the detection of an injury requiring intervention were identical for both groups of interpreters and were 0.17 for negative result and 35.6 for positive result. Conclusion: The accuracy of computed tomography for evaluating blunt abdominal trauma at a low-volume institution is comparable to that reported from higher-volume centers and may be the procedure of choice, averting the expected higher incidence of nontherapeutic laparotomy attendant with more widespread application of diagnostic peritoneal lavage and the missed injuries that may be expected from the occasional ultra-sonographer.