Blunt trauma patients may be discharged after negative abdomen CT

By Anne Harding

NEW YORK (Reuters Health) - Negative computed tomography (CT) imaging of the abdomen is highly sensitive for ruling out clinically significant injury in asymptomatic blunt trauma patients, new research shows.

"The findings in this study support that asymptomatic patients with negative abdominal imaging after trauma are exceedingly unlikely to have significant intra abdominal injury and can likely safely be discharged home," Dr. Elizabeth R. Benjamin, of the University of Southern California Medical Center in Los Angeles, told Reuters Health by email.

"It is important to note, however, that this is a retrospective study and, although (it) reports results from a large volume of patients, is not our highest level of evidence and therefore all conclusions should be interpreted with caution," she said.

Currently, it is not clear when patients with negative abdominal CT after blunt trauma can be safely discharged, Dr. Benjamin and her team note in their report, published online September 9 in a Research Letter in JAMA Surgery.

"There are no set guidelines for this patient population and, as such, there is significant institutional variability," Dr. Benjamin said. "Most physicians will consider mechanism of injury and associated injuries in deciding duration of observation. The lack of clear guidelines is one of the main reasons why this study was performed."

She and her colleagues looked at 620 blunt trauma patients admitted to their emergency room in 2013 who had negative findings after CT of the abdomen and pelvis. Just over half of the patients spent more than 24 hours in the surgical observation unit, while the remaining patients were discharged within 24 hours of admission.

Most of the trauma came from automobile accidents (n=303), automobiles vs pedestrians (n=117), and motorcycle collisions (n=76).

Most of the 324 (52.3%) patients who spent more than 24 hours in the hospital were receiving orthopedic management (n=168), treatment of comorbidities, continued workup (n=57), or additional imaging (n=55).

None of the patients who had negative CT findings was found to have delayed abdominal injuries, including those who had abdominal pain and the "seat belt sign."

"Although further prospective analysis with multicenter participation will be needed to better characterize these results, based on these data, asymptomatic evaluable patients with a negative abdominal CT finding can likely be safely discharged from the hospital or dispositioned to another treating service," the researchers concluded.

"We have just finished enrollment in a prospective study on the same topic with the goal of providing additional evidence to support specific management guidelines for patients with negative abdominal imaging after trauma," Dr. Benjamin said.

She added, "After trauma, it is extremely important that we provide safe and efficient care for our patients. Our goal is to critically evaluate patients, identify all injuries, and provide treatment or follow-up as needed in a timely and safe fashion. Imaging, specifically CT scans, have become a key element in this evaluation and in many cases are indispensable. It is important to balance, however, the importance of the information gathered from imaging with the radiation burden on the individual patient."

The authors reported no disclosures.

SOURCE: http://bit.ly/1gUZ0cA

JAMA Surg 2015.

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