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Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury

Abstract : Objectives To evaluate the performance of an early repeated computed tomography (rCT) in initially non-operated patients with blunt bowel and mesenteric injuries (BBMI). Methods This was a monocentric retrospective observational study from 2009 to 2017 of patients with a BBMI on initial CT (iCT). Patients initially non-operated on were scheduled for a rCT within 48 h. Initial CT and rCT diagnostic performance were compared based on a surgical injury prediction score previously described. For statistical analysis, we used the chi-square analyses for paired data (McNemar test). Results Eighty-four patients (1.9% of trauma) had suspected BBMI on iCT. Among these patients, 22 (26.2%) were initially operated on, 18 (21.4%) were later operated on, and 44 (52.4%) were not operated on. The therapeutic laparotomy rate was 85%. Thirty-four patients initially non-operated on had a rCT. The absolute value of the CT scan score increased for 15 patients (44.1%). The early rCT diagnostic performance, compared with iCT, showed an increase in sensitivity (from 63.6 to 91.7%), in negative predictive value (from 77.4 to 94.7%), and in AUC (from 0.77 to 0.94). Conclusion In initially non-operated patients with BBMI lesions, the performance of an early rCT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for non-operative treatment.
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https://hal-amu.archives-ouvertes.fr/hal-02445697
Contributor : Isabelle Combe Connect in order to contact the contributor
Submitted on : Monday, January 20, 2020 - 1:31:02 PM
Last modification on : Thursday, April 14, 2022 - 10:21:52 AM

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F. Lannes, U. Scemama, A. Maignan, L. Boyer, L. Beyer-Berjot, et al.. Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury. European Radiology, Springer Verlag, 2019, 29 (11), pp.5932-5940. ⟨10.1007/s00330-019-06212-w⟩. ⟨hal-02445697⟩

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