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European Radiology
Published in: European Radiology 11/2016

01-11-2016 | Emergency Radiology

Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study

Authors: Nitima Saksobhavivat, Kathirkamanathan Shanmuganathan, Alexis R. Boscak, Clint W. Sliker, Deborah M. Stein, Uttam K. Bodanapally, Krystal Archer-Arroyo, Lisa A. Miller, Thorsten R. Fleiter, Melvin T. Alexander, Stuart E. Mirvis, Thomas M. Scalea

Published in: European Radiology | Issue 11/2016

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Abstract

Purpose

Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined.

Materials and methods

This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation. The primary outcome measures were operative findings and clinical follow-up. CT results were compared with the primary outcome measures.

Results

Of one hundred and seventy-one patients (72 gunshot wounds, 99 stab wounds; age range, 18–57 years; median age, 28 years) with penetrating torso trauma who underwent CT, 45 % were followed by an operation and 55 % by clinical follow up. Thirty-five patients had a gastrointestinal injury at surgery. The sensitivity, specificity, and accuracy of CT for diagnosing a gastrointestinal injury for all patients were each 91 %, and for predicting the need for surgery, they were 94 %, 93 %, 93 %, respectively. Among the 3 % of patients who failed observation, 1 % had a gastrointestinal injury.

Conclusion

CT is a useful technique to diagnose gastrointestinal injury following penetrating torso injury. CT can help discriminate patients requiring observation or surgery.

Key Points

• The most sensitive sign is wound tract extending up to gastrointestinal wall.
• The most accurate sign is gastrointestinal wall thickening.
• Triple-contrast CT is a useful technique to diagnose gastrointestinal injury.
• Triple-contrast CT helps to discriminate patients requiring observation and surgery.
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Metadata
Title
Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study
Authors
Nitima Saksobhavivat
Kathirkamanathan Shanmuganathan
Alexis R. Boscak
Clint W. Sliker
Deborah M. Stein
Uttam K. Bodanapally
Krystal Archer-Arroyo
Lisa A. Miller
Thorsten R. Fleiter
Melvin T. Alexander
Stuart E. Mirvis
Thomas M. Scalea
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4260-3

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