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European Journal of Trauma and Emergency Surgery

, Volume 44, Issue 5, pp 779–785 | Cite as

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

  • Mahery Raharimanantsoa
  • Tobias Zingg
  • Alicia Thiery
  • Cécile Brigand
  • Jean-Baptiste Delhorme
  • Benoît Romain
Original Article

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.

Keywords

Blunt trauma Score Lactates Road traffic crash Bowel injury Mesenteric injury 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Funding

None.

Supplementary material

68_2017_893_MOESM1_ESM.docx (194 kb)
Supplementary material 1 (DOCX 193 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Mahery Raharimanantsoa
    • 1
  • Tobias Zingg
    • 2
  • Alicia Thiery
    • 3
  • Cécile Brigand
    • 1
  • Jean-Baptiste Delhorme
    • 1
  • Benoît Romain
    • 1
  1. 1.Department of Digestive SurgeryStrasbourg UniversityStrasbourgFrance
  2. 2.Department of Visceral SurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  3. 3.Department of Public Health CareStrasbourg UniversityStrasbourgFrance

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