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Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

  • Emergency Radiology
  • Published:
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Abstract

Objectives

To evaluate the performance of a computed tomography (CT) diagnostic score to predict surgical treatment for blunt bowel and/or mesentery injury (BBMI) in consecutive abdominal trauma.

Methods

This was a retrospective observational study of 805 consecutive abdominal traumas with 556 patients included and screened by an abdominal radiologist blinded to the patient outcome, to evaluate numerous CT findings and calculate their diagnostic performances. These CT findings were compared using univariate and multivariate analysis between patients who had a laparotomy-confirmed BBMI requiring surgical repair, and those without BBMI requiring surgery. A CT score was obtained with an internal bootstrap validation.

Results

Fifty-six patients (10.1 %) had BBMI requiring surgery. Nine CT signs were independently associated with BBMI requiring surgery and were used to develop a CT diagnostic score. The AUC of our model was 0.98 (95 % CI 0.96–100), with a ≥5 cut-off. Its diagnostic performance was determined by internal validation: sensitivity 91.1–100 %, specificity 85.7–97.6 %, positive predictive value 41.4–82.3 % and negative predictive value 98.9–100 %. Bowel wall discontinuity and mesenteric pneumoperitoneum had the strongest association with BBMI requiring surgery (OR = 128.9 and 140.5, respectively).

Conclusion

We developed a reliable CT scoring system which is easy to implement and highly predictive of BBMI requiring surgery.

Key Points

• Finding of bowel wall discontinuity or mesenteric pneumoperitoneum indicates BBMI requiring surgery.

• Arterial mesenteric vessel extravasation requires surgery when in association with other CT findings.

• Our CT scoring system has excellent diagnostic performance in predicting BBMI requiring surgery.

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Acknowledgements

The scientific guarantor of this publication is Prof. Taourel. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Imaging, CHU Lapeyronie, 371 avenue Gaston Giraud, 34295, Montpellier, France

    Claire Faget, Patrice Taourel, Alban Ruyer, Chakib Alili & Ingrid Millet

  2. Department of Medical Information and Statistics, UMR 729 MISTEA, CHU Montpellier, Montpellier, France

    Nicolas Molinari

  3. Department of Intensive Care and Anesthesiology, CHU Lapeyronie, Montpellier, France

    Jonathan Charbit

Authors
  1. Claire Faget
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  2. Patrice Taourel
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  3. Jonathan Charbit
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  4. Alban Ruyer
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  5. Chakib Alili
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  6. Nicolas Molinari
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  7. Ingrid Millet
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Correspondence to Ingrid Millet.

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Faget, C., Taourel, P., Charbit, J. et al. Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system. Eur Radiol 25, 3620–3628 (2015). https://doi.org/10.1007/s00330-015-3771-7

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  • DOI: https://doi.org/10.1007/s00330-015-3771-7

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