2010 Papers - Plackett

Effects of CT Scanning for Abdominal Gunshot Wounds

Timothy Plackett Department of Surgery, Tripler Army Medical Center

Background: The use of CT scan is an important tool in the selection of gunshot wound patients able to be managed non-operatively. While multiple studies have debated the sensitivity and specificity of CT scans to determine specific injuries, few studies have examined the impact that its use has had on the percentage of patients undergoing surgery.

Methods: A retrospective review was performed of patients presenting for anterior abdominal gunshot wounds at a Level I center between January 1, 1998 and October 31, 2008. The primary endpoints were operative intervention and use of CT scan. Secondary outcomes were the negative laparotomy rate, length of hospital stay, and mortality.

Results: A total of 1,224 patients sustained a gunshot wound to the abdomen. During the study time period the percentage of patients undergone exploratory laparotomy increased from 36.6% in 1998 to 56.4% in 2008 (p<0.03). The percentage of patient undergoing an immediate exploratory laparotomy was unchanged (55.2% of all patients), whereas the percentage of patients undergoing a delayed laparotomy was significantly increased 3.0% of all patient in 1998 to 12.7% of all patients in 2008 (p<0.05). For those patients managed without an immediate surgery, the use of CT scan increased significantly from 2.6% of patients in 1998 to 68.0% of patients in 2008 (p <0.05). This correlated with an increase in the percentage of these patient undergoing an eventual exploratory laparotomy from 5.1% in 1998 to 28.0% in 2008 (p<0.05). There was no change in the mean injury severity score (13.9 0.4), mean abdominal adjusted injury score (2.5 0.0) or the percentage of patients with polytrauma (41.3%) during the study time period. Despite the increased use of CT scans there was no change in the percentage of negative laparotomies (13.0%) or non-therapeutic laparotomies (4.2%). There was no change in the overall mortality (15.4%), ICU length of stay (3.0 days), or hospital length of stay (11.3 days).

Conclusions: The increased use of CT scans correlates with the increase in the percentage of patients undergoing an exploratory laparotomy for an anterior abdominal gunshot wound. However, using the outcome measures presented, there was no benefit to patient associated with the use of CT scanning.