Proposal of a New Preliminary Scoring Tool for Early Identification of Significant Blunt Bowel and Mesenteric Injuries in Patients at Risk After Road Traffic Crashes

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2017 Dec 16

PMID 29242951

Citations 8

Authors

Mahery Raharimanantsoa

Tobias Zingg

Alicia Thiery

Cecile Brigand

Jean-Baptiste Delhorme

Benoit Romain

Affiliations

Soon will be listed here.

Abstract

Purpose: Blunt bowel and mesenteric injuries (BBMI) are regularly missed by abdominal computed tomography (CT) scans. The aim of this study was to develop a risk assessment tool for BBMI to help clinicians in decision-making for blunt trauma after road traffic crashes (RTCs).

Methods: Single-center retrospective study of trauma patients from January 2010 to April 2015. All patients admitted to our hospital after blunt trauma following RTCs and CT scan at admission were assessed.

Results: Of the 394 patients included, 78 (19.8%) required surgical exploration and 34 (43.6%) of these had a significant BBMI. A univariate and multivariate analysis were performed comparing patients with BBMI (n = 34) and patients without BBMI (n = 360). A score with a range from 0 to 13 was created. Scores from 8 to 9 were associated with 5-25% BBMI risk. The power of this new score ≥ 8 to predict a surgically significant BBMI had a sensitivity of 96%, specificity of 86.4%, positive predictive value (PPV) of 48% and negative predictive value (NPV) of 99.4%.

Conclusion: This score could be a valuable tool for the management of blunt trauma patients after RTA without a clear indication for laparotomy but at risk for BBMI. The outcome of this study suggests selective diagnostic laparoscopy for a score ≥ 8 in obtunded patients and ≥ 10 in all other. To assess the value and accuracy of this new score, a prospective validation of these retrospective findings is due.

Citing Articles

Predictive parameters for early detection of clinically relevant abdominal trauma in multiple-injury or polytraumatised patients: a retrospective analysis.

Fabig S, Weigert N, Migliorini F, Kleeff J, Hofmann G, Schenk P Eur J Med Res. 2024; 29(1):394.

PMID: 39080791 PMC: 11288090. DOI: 10.1186/s40001-024-01969-3.

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT.

Iacobellis F, Di Serafino M, Caruso M, DellAversano Orabona G, Rinaldo C, Grimaldi D Diagnostics (Basel). 2023; 13(7).

PMID: 37046565 PMC: 10093738. DOI: 10.3390/diagnostics13071347.

Bucket-Handle Mesenteric Tears: A Comprehensive Review of Their Presentation and Management.

Chowdhury A, Burford C, Pangeni A, Shrestha A Cureus. 2022; 14(9):e28692.

PMID: 36199643 PMC: 9527005. DOI: 10.7759/cureus.28692.

Protective Role of Obesity on Trauma Impact: A Retrospective Analysis of Patients with Surgical Blunt Bowel Mesenteric Injury Due to Road Traffic Accidents.

Hsieh T, Chuang P, Liu C, Wu B, Liu Y, Hsieh C Risk Manag Healthc Policy. 2022; 15:1533-1543.

PMID: 36003412 PMC: 9395217. DOI: 10.2147/RMHP.S374469.

A Retrospective Cohort Study on the Clinical Characteristics of Patients with Surgical Blunt Bowel and/or Mesenteric Injuries among Motorcyclists and Car Occupants.

Hsieh T, Chuang P, Liu C, Wu B, Hsieh C Healthcare (Basel). 2022; 10(7).

PMID: 35885849 PMC: 9323956. DOI: 10.3390/healthcare10071323.

References

Jansen T, Van Bommel J, Mulder P, Rommes J, Schieveld S, Bakker J . The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008; 12(6):R160. PMC: 2646325. DOI: 10.1186/cc7159. View

Brofman N, Atri M, Hanson J, Grinblat L, Chughtai T, Brenneman F . Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006; 26(4):1119-31. DOI: 10.1148/rg.264055144. View

Shin J, Shin J, Ko H, Kim J, Yoon H . Transcatheter arterial embolization for traumatic mesenteric bleeding: a 15-year, single-center experience. Diagn Interv Radiol. 2016; 22(4):385-9. PMC: 4956026. DOI: 10.5152/dir.2016.15413. View

Jha N, Yadav S, Sharma R, Sinha D, Kumar S, Kerketta M . Characteristics of Hollow Viscus Injury following Blunt Abdominal Trauma; a Single Centre Experience from Eastern India. Bull Emerg Trauma. 2016; 2(4):156-60. PMC: 4771291. View

Burney R, Mueller G, Coon W, Thomas E, MacKenzie J . Diagnosis of isolated small bowel injury following blunt abdominal trauma. Ann Emerg Med. 1983; 12(2):71-4. DOI: 10.1016/s0196-0644(83)80374-6. View

Joseph D, Kunac A, Kinler R, Staff I, Butler K . Diagnosing blunt hollow viscus injury: is computed tomography the answer?. Am J Surg. 2013; 205(4):414-8. DOI: 10.1016/j.amjsurg.2012.12.003. View

Jones E, Stovall R, Jones T, Bensard D, Burlew C, Johnson J . Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours. J Trauma Acute Care Surg. 2014; 76(4):1020-3. PMC: 4091734. DOI: 10.1097/TA.0000000000000131. View

Demetriades D, Vandenbossche P, Ritz M, Goodmann D, Kowalszik J . Non-therapeutic operations for penetrating trauma: early morbidity and mortality. Br J Surg. 1993; 80(7):860-1. DOI: 10.1002/bjs.1800800716. View

Rodriguez C, Barone J, Wilbanks T, Miller K . Isolated free fluid on computed tomographic scan in blunt abdominal trauma: a systematic review of incidence and management. J Trauma. 2002; 53(1):79-85. DOI: 10.1097/00005373-200207000-00016. View

10.

Federle M, Jeffrey Jr R . Hemoperitoneum studied by computed tomography. Radiology. 1983; 148(1):187-92. DOI: 10.1148/radiology.148.1.6856833. View

11.

Fang J, Chen R, Lin B . Cell count ratio: new criterion of diagnostic peritoneal lavage for detection of hollow organ perforation. J Trauma. 1998; 45(3):540-4. DOI: 10.1097/00005373-199809000-00021. View

12.

Zarour A, El-Menyar A, Khattabi M, Tayyem R, Hamed O, Mahmood I . A novel practical scoring for early diagnosis of traumatic bowel injury without obvious solid organ injury in hemodynamically stable patients. Int J Surg. 2014; 12(4):340-5. DOI: 10.1016/j.ijsu.2014.01.011. View

13.

Fakhry S, Watts D, Luchette F . Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003; 54(2):295-306. DOI: 10.1097/01.TA.0000046256.80836.AA. View

14.

Mathonnet M, Peyrou P, Gainant A, Bouvier S, Cubertafond P . Role of laparoscopy in blunt perforations of the small bowel. Surg Endosc. 2003; 17(4):641-5. DOI: 10.1007/s00464-002-9049-6. View

15.

Mitsuhide K, Junichi S, Atsushi N, Masakazu D, Shinobu H, Tomohisa E . Computed tomographic scanning and selective laparoscopy in the diagnosis of blunt bowel injury: a prospective study. J Trauma. 2005; 58(4):696-701. DOI: 10.1097/01.ta.0000159242.93309.f6. View

16.

Fakhry S, Brownstein M, Watts D, Baker C, Oller D . Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000; 48(3):408-14; discussion 414-5. DOI: 10.1097/00005373-200003000-00007. View

17.

Villavicencio R, Aucar J . Analysis of laparoscopy in trauma. J Am Coll Surg. 1999; 189(1):11-20. DOI: 10.1016/s1072-7515(99)00052-6. View

18.

Rossi P, Mullins D, THAL E . Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg. 1993; 166(6):707-10; discussion 710-1. DOI: 10.1016/s0002-9610(05)80684-1. View

19.

Bossuyt P, Reitsma J, Bruns D, Gatsonis C, Glasziou P, Irwig L . STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015; 351:h5527. PMC: 4623764. DOI: 10.1136/bmj.h5527. View

20.

Porter R, Zhao N . Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited. Ann Emerg Med. 1998; 32(4):418-24. DOI: 10.1016/s0196-0644(98)70169-6. View