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Comparative study of multidetector computed tomography and ultrasonography findings in blunt abdominal trauma.

INTRODUCTION

Ultrasound is rapid, reliable, cost effective and easily available imaging modality with unique ability to detect free fluid in abdomen. (1) Comprehensive evaluation of actively injured patient is frequently impossible due to rib fracture, wounds and gaseous distension of bowel. CT is not only sensitive and specific, but also provides global evaluation of abdomen and retroperitoneum. CT provides exact location of injury and its extent, so trend towards conservative management of liver, spleen and kidney injuries is increasing and also number of negative laparotomies are reduced. (2)

"Focused Assessment with Sonography for Trauma" (FAST) is a method to detect intraperitoneal fluid in an emergency setting. Second generation ultrasound with improved resolution and multiple frequency probes improve the specificity of ultrasound evaluation in blunt abdominal trauma. (3,4) Even with improved ultrasound machines about 50% of the solid organ injuries are missed, hence cannot replace CT. Computed tomography has been introduced to evaluate patients with blunt abdominal trauma among the FAST positive, indeterminate and clinically suspicious cases of solid organ, hollow viscera, spine and pelvis injury. (5,6)

AIM AND OBJECTIVES

The purpose of this study was to evaluate sensitivity, specificity and diagnostic efficacy of USG and CT in detecting free fluid in abdomen and abdominal organ injuries in patients with blunt abdominal trauma and then compare the sensitivity, specificity and diagnostic accuracy of the two imaging modalities in detecting free fluid in abdomen and abdominal organ injury.

MATERIALS AND METHOD

A prospective observational study of 100 patients of blunt abdominal trauma with suspected abdominal organ injury was conducted over a period of 2 years from July 2010 to August 2012 in the Department of Radiodiagnosis and Imaging, Bharati Hospital, Pune. Ethical clearance was taken from College Ethical Committee. Informed written consent was taken from patient or relative.

FAST screening was done with ANTARES ACUSON SIEMENS followed by MDCT study on 16 SLICE PHILIPS BRILLIANCE.

USG Technique

FAST was done as a quick screening test and abdomen was screened for free fluid in peritoneal cavity and abdominal organ injuries.

CT Scan Technique

Scan protocol: 120-140 KVP, 200-250 mAs, Pitch 1.5, Field of view 240-300 mm, Collimation 2.5 mm (3.2 mm effective). Initially unenhanced images of the abdomen and pelvis were obtained. Subsequently, non-ionic contrast of concentration 400 mg/mL was administered at 1.5 mL/kg body weight in adults and children, and was injected @ 2-3 mL/second through intravenous cannula using a pressure injector. Multiphase contrast study was done in each patient.

The findings of USG were compared with those of MDCT in detail. Confirmatory correlation was made with laparotomy findings in available cases. Statistical analysis was performed pertaining to sensitivity, specificity and diagnostic accuracy of USG and MDCT separately and the two results were compared.

Statistical analysis was done using the formula: Sensitivity=true positive/(true positive + false negative) x 100, Specificity=true negative/(true negative + false positive) x 100, Diagnostic accuracy=(true negative + true positive)/(true negative + true positive + false negative + false positive).

RESULT

Of the total 100 patients, 52 patients were in the age group of 21-40 years, which is the most active span of life. Of 100 patients, 78 were male and 22 were female with male:female ratio of 3.5:1 and the most common mode of trauma was road traffic accident (66%) followed by fall from height (28%). Of all the patients, 90% had abdominal organ injury and haemoperitoneum was found in 90% of cases.

The most common organs injured were spleen and liver, 34 patients each followed by kidney 24 patients. USG showed sensitivity of 100%, specificity of 62.5% and overall diagnostic accuracy of 94% as compared to that of CT, which showed 100% sensitivity, 100% specificity and diagnostic accuracy of 100% for detection of free intraperitoneal fluid. Also, USG showed sensitivity of 68.8%, specificity of 80% and overall diagnostic accuracy of 70% as compared to CT which showed 97.7% sensitivity, 100% specificity and overall diagnostic accuracy of 98% for detection of abdominal organ injuries.

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DISCUSSION

In this study, a male predominance was found with male:female ratio of 3.5:1, which was also noted by William Pevec, Andres Peitzman, Anthony Udekwu et al and Srisussadaporn S. (7,8)

Fifty two percent (52%) patients were in the age group of 21-40 years, the most active span of life, when people are prone for injuries, also demonstrated by Stuart E. Mirvis, Nancy O. Whitley, David R. Gens. (9,10)

The commonest mode of trauma was road traffic accident accounting for 66% of total cases. This is similar to findings by Srisussadaporn S. (8)

In this study, spleen and liver were the most common organs injured followed by kidney, which was similar to study by Barry D. Toombs, Richard G. Lester, Yoram Ben Menachem et al. (11)

In this study USG showed sensitivity of 100%, specificity of 62.5% and overall diagnostic accuracy of 94% as compared to that of CT, which showed 100% sensitivity, 100% specificity and diagnostic accuracy of 100% for detection of free intraperitoneal fluid, which were very well comparable with other studies by Paolo Lucciarini, Schmuel Katz, Sattam S. Lingawi, Vivian W. Wing, Paul A. Kearney, William Pevec and S. Srisussadapom. (18,12,13,44,15,16)

In this study USG showed sensitivity of 68.8%, specificity of 80% and overall diagnostic accuracy of 70% as compared to CT which showed 97.7% sensitivity, 100% specificity and overall diagnostic accuracy of 98% for detection of abdominal organ injuries, which were very well comparable with other studies by Paolo Lucciarini, Schmuel Katz, Sattam S. Lingawi, Vivian W. Wing, Paul A. Kearney, William Pevec and S. Srisussadapom. (8,12,13,14,15,16)

CONCLUSION

Ultrasound is an efficient imaging modality in the initial evaluation of patients with blunt abdominal trauma. But CT is the superior diagnostic modality. CT scan thoroughly scrutinizes entire abdomen including retroperitoneum with additional assessment of thoracic trauma and bony pelvic trauma. Hence, CT increases diagnostic confidence and influences management decision.

REFERENCES

(1.) Sutton D. A textbook of radiology and imaging. 7th edn. vol. 1. India: Elsevier 2009:691-702.

(2.) Neish AS, Taylor GA, Lund DP, et al. Effect of CT information on the diagnosis and management of acute abdominal injury in children. Radiology 1998; 206 (2):327-31.

(3.) Scalea TM, Rodriguez A, Chiu WC, et al. FAST consensus conference committee. Result from an international consensus conference. J Trauma 1999;46(3):466-72.

(4.) Goldbergs BB, Goodman GA, Clearfield HR. Evaluation of ascites by ultrasound. Radiology 1970;96(1):15-22.

(5.) Federle MP. Computed tomography of blunt abdominal trauma. RCNA 1983;21(3):461-75.

(6.) Federle MP, Kaiser JA, McAninch JW, et al. The role of computed tomography in renal trauma. Radiology 1981;141:455-60.

(7.) Pevec WC, Peitzman AB, Udekwu AO, et al. Computed tomography in the evaluation of blunt abdominal trauma. Surgery Gynaecology & Obstetrics 1991;173(4):262-7.

(8.) Srisussadaporn S. CT scan in blunt abdominal trauma. Injury 1993;24(8):514-44.

(9.) Mirvis SE, Whitley NO, Gens DR. Blunt splenic trauma in adults: CT based classification and correlation with prognosis and treatment. Radiology 1989;171(1):33-9.

(10.) Rumack CM, Wilson SR, Charboneay JW. Eds. Diagnostic ultrasound. vol 1. 3rd edn. Missouri: Mosby-Year Book Inc 1992:137-9.

(11.) Toombs BD, Lester RG, Menachem YB, et al. Computed tomography in blunt abdominal trauma. RCNA 1981;19(1):17-35.

(12.) Lucciarini P, O'fner D, Weber F, et al. Ultrasonography in the initial evaluation & follow up of blunt abdominal injury. Surgery 1993;114(3):506-12.

(13.) Katz S, Lazar L, Rathaus V, et al. Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma? J Paediatric Surgery 1996;31(5):649-51.

(14.) Lingawi SS, Buckley AR. Focused abdominal ultrasonography in patient with trauma. Radiology 2000;217(2):426-9.

(15.) Wing VW, Federle MP, Morris JA, et al. The clinical impact of computed tomography for blunt abdominal trauma. AJR 1985;145(6):1191-4.

(16.) Kearney PA, Vahey T, Burney RE, et al. Computerized tomography and diagnostic peritoneal lavage in blunt abdominal trauma. Arch Surg 1989;124(3):344-7.

Okram Pusparani Devi [1], Yengkhom Rameshwor Singh [2], Tonjam HemchandSingh [3]

[1] Assistant Professor, Department of Radiodiagnosis, JNMS, Imphal.

[2] Assistant Professor, Department of Paediatrics, JNIMS, Imphal.

[3] Assistant Professor, Department of Psychiatry, JNIMS, Imphal.

Financial or Other, Competing Interest: None.

Submission 16-06-2016, Peer Review 18-07-2016, Acceptance 23-07-2016, Published 01-08-2016.

Corresponding Author:

Dr. Okram Pusparani Devi, C/o. Dr. Yengkhom Rameshwor Singh, Thoubal Haokha, Maning Leikai, P.O. Thoubal, Manipur--795138.

E-mail: drpuspaokram @gmail.com

DOI: 10.14260/jemds/2016/982
Table 1: Age and Sex Distribution (n=100)

Sl. No.    Age Group (Years)    Male   Female   Total

1                0-10            12      8       20
2                11-20           12      2       14
3                21-30           30      4       34
4                31-40           12      6       18
5                41-50           6       0        6
6                51-60           6       0        6
7                61-70           0       0        0
8                71-80           0       2        2

Total                            78      22      100

Table 2: Distribution of Patients According to Mechanism of
Injury (n=100)

Sl. No.            Mode of Trauma            No. of Patients

1              Road traffic accident               66
2                 Fall from height                 28
3         Fall of heavy object on abdomen           4
4                      Others                       2
Total                                              100

Table 3: Distribution of Patients According to Organ Injury (n=100)

Sl. No.   Organ                Positive on   Positive on   No. of Cases
                               Ultra-sound     CT Scan      Confirmed

1         Spleen                   24            34             34
2         Liver                    22            34             34
3         Kidney                   20            24             24
4         Pancreas                  4             6             6
5         Retroperitoneal           2             6             6
            Haematoma
6         Urinary Bladder           0             2             2
7         Mesentery                 0             6             6
8         Bowel                     0             2             2
9         Pleural Collection       14            16             16
10        Psoas Haematoma           4             8             8
11        Ureter                    0             2             2
12        Adrenal Gland             2             4             4
13        Uterus                    2             2             2
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Article Details
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Title Annotation:Original Research Article
Author:Devi, Okram Pusparani; Singh, Yengkhom Rameshwor; Singh, Tonjam Hemchand
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Aug 1, 2016
Words:1647
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