Routine computed tomography after recent operative exploration for penetrating trauma: What injuries do we miss?

BACKGROUND: Patients with penetrating trauma who cannot be stabilized undergo operative intervention without preoperative imaging. In such cases, post-operative imaging may reveal additional injuries not identified during the initial operative exploration. The purpose of this study is to explore the utility of post-operative CT imaging in the setting of penetrating trauma.

METHODS: This was a retrospective analysis of patients with penetrating trauma treated at an urban level 1 trauma center between 2010-2015. Patients were included if they underwent an emergent laparotomy without preoperative imaging. Patients were excluded if they had prior imaging or concomitant blunt injury. For the purposes of this study, occult injury was defined as a CT scan finding not mentioned in the first operative report. Descriptive statistics were utilized to compare patient characteristics who had received imaging immediately post-operatively to those who had not.

RESULTS: During the 5-year study period, 328 patients who had a laparotomy for penetrating trauma over the study period, 225 patients met the inclusion criteria. Seventy-three (32%) patients underwent CT scanning immediately post-operatively with occult injuries identified in 38 (52%). The most frequent occult injuries were orthopedic (20/43) and genitourinary (9/43). Importantly, 10 of the 38 patients (26%) required an intervention for these occult injuries. Those selected for immediate post-operative imaging were more likely to have sustained gunshot wounds and were significantly more severely injured (higher ISS and longer LOS) when compared to patients who did not receive immediate imaging.

CONCLUSION: We recommend the use of immediate post-operative CT after emergent laparotomy especially when there is a high index of suspicion for spine or genitourinary injuries and in patients who have sustained ballistic penetrating injuries.

LEVEL OF EVIDENCE: Therapeutic/Care management, level IV; Diagnostic Tests or Criteria, level IV.