Limiting computed tomography to patients with peritoneal lavage-positive results reduces cost and unnecessary celiotomies in blunt trauma

Martin A. Schreiber, Larry M. Gentilello, Peter Rhee, Gregory J. Jurkovich, Ronald V. Maier

    Research output: Contribution to journalArticle

    15 Scopus citations

    Abstract

    Objective: To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy. Design: Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 1011/L (105/mm3) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy. Results: Sixty-seven hemodynamically stable patients had a red blood cell count greater than 1011/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P<.01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580 594 over a period of 2 years. Conclusion: Limiting CT to the evaluation of patients with DPL- positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of non-therapeutic celiotomies compared with DPL alone.

    Original languageEnglish (US)
    Pages (from-to)954-959
    Number of pages6
    JournalArchives of Surgery
    Volume131
    Issue number9
    DOIs
    StatePublished - Sep 1996

    ASJC Scopus subject areas

    • Surgery

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