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.

Details

Serval ID
serval:BIB_235CDD51B6AC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
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.
Journal
European journal of trauma and emergency surgery
Author(s)
Raharimanantsoa M., Zingg T., Thiery A., Brigand C., Delhorme J.B., Romain B.
ISSN
1863-9941 (Electronic)
ISSN-L
1863-9933
Publication state
Published
Issued date
10/2018
Peer-reviewed
Oui
Volume
44
Number
5
Pages
779-785
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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).
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.
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%.
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.
Keywords
Abdominal Injuries/diagnostic imaging, Abdominal Injuries/surgery, Accidents, Traffic, Early Diagnosis, Female, France, Humans, Injury Severity Score, Male, Mesentery/injuries, Predictive Value of Tests, Retrospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed, Wounds, Nonpenetrating/diagnostic imaging, Wounds, Nonpenetrating/surgery, Blunt trauma, Bowel injury, Lactates, Mesenteric injury, Road traffic crash, Score
Pubmed
Web of science
Create date
11/01/2018 18:00
Last modification date
20/08/2019 13:01
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