Computerized Axial Tomography in patients with severe abdominal trauma: is it a justifiable risk?

ABSTRACT Objective: to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. Methods: retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. Results: considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. Conclusion: CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.

摘要 目的：评估触发大量输血方案、且在急诊室（ER）接受轴向计算机断层扫描（Computed Axial Tomography，CAT）的严重腹部创伤患者的病情转归，以验证该类患者的预后情况，以及轴向计算机断层扫描在此临床场景下的诊断效能。方法：本研究为回顾性纵向观察性研究，于巴西巴拉那州库里提巴的创伤救治转诊中心开展。我们纳入60名触发大量输血方案的严重腹部创伤患者，将其分为两组：在急诊室接受轴向计算机断层扫描的患者组，以及未接受该项检查的患者组。我们评估了该CT检查的诊断准确度，并对比两组患者的死亡例数、住院时长以及输注的血液成分量。结果：纳入的全部60名患者中，66.67%的患者在急诊室接受了红细胞输注；33.3%的患者因血流动力学改善于入院时接受了轴向计算机断层扫描，其余66.7%的患者入院时未进行该项检查。两组患者的死亡率均为35%。对比两组数据，其平均住院时长的差异无统计学意义，平均输注红细胞量的差异同样无统计学意义。在接受轴向计算机断层扫描的患者组中，45%的患者无需接受剖腹探查术。结论：对于急诊室就诊时存在血流动力学不稳定的患者，可快速完成轴向计算机断层扫描，此举可使部分患者免于不必要的剖腹探查术，且不会对患者死亡率产生显著影响。