Comparative study of multidetector computed tomography and ultrasonography findings in blunt abdominal trauma.
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.
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).
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.
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)
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.
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Okram Pusparani Devi , Yengkhom Rameshwor Singh , Tonjam HemchandSingh 
 Assistant Professor, Department of Radiodiagnosis, JNMS, Imphal.
 Assistant Professor, Department of Paediatrics, JNIMS, Imphal.
 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.
Dr. Okram Pusparani Devi, C/o. Dr. Yengkhom Rameshwor Singh, Thoubal Haokha, Maning Leikai, P.O. Thoubal, Manipur--795138.
E-mail: drpuspaokram @gmail.com
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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|Title Annotation:||Original Research Article|
|Author:||Devi, Okram Pusparani; Singh, Yengkhom Rameshwor; Singh, Tonjam Hemchand|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Aug 1, 2016|
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