Will computed tomography (CT) miss something? the characteristics and pitfalls of torso CT in evaluating patients with blunt solid organ trauma

Abstract

Background Selective nonoperative management has become the standard care for blunt solid organ trauma patients, and torso computed tomography (CT) provides useful therapeutic clues. We conducted this study to determine the frequency and character of missed diagnoses in blunt solid organ trauma patients. METHODS We reviewed the medical records of all blunt trauma patients who underwent torso CT and who were admitted for solid organ injuries (liver, spleen and kidney) at the Chi-Mei Medical Center from August 2003 to October 2006. RESULTS The patients were divided into the Missed Group (24 patients) and the Unaltered Group (262 patients) according to the presence or absence of a missed diagnosis. The overall missed diagnosis rate was 8.4%. Only one unidentified bowel injury was disclosed by follow-up CT, and all of the missed injuries were revealed by laparotomy. The Missed Group had a higher Injury Severity Score, lower Glasgow Coma Scale, more Intensive Care Unit (ICU) care, and longer duration of hospitalization. CONCLUSION Discovery of missed diagnoses is not uncommon in patients who sustain severe trauma. Laparotomy revealed all of the missed diagnoses, and follow-up CT demonstrated a poor ability to detect unidentified injuries. We suggest laparotomy instead of follow-up CT in the nonoperative management of patients with blunt solid organ injuries if clinical deterioration occurs.