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Research Letter |

Negative Finding From Computed Tomography of the Abdomen After Blunt Trauma

Elizabeth R. Benjamin, MD, PhD1; Stefano Siboni, MD1; Tobias Haltmeier, MD1; Alexander Lofthus, BA1; Kenji Inaba, MD1; Demetrios Demetriades, MD, PhD1
[+] Author Affiliations
1Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
JAMA Surg. 2015;150(12):1194-1195. doi:10.1001/jamasurg.2015.1649.
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This study investigates whether a negative computed tomographic finding following blunt trauma is sufficient for ruling out intra-abdominal injury.

Despite the focus on time management, cost-efficient health management, resource utilization, and the growing evidence regarding the long-term effects of radiation exposure, the liberal use of computed tomography (CT) for trauma remains common. Determining which patients require CT imaging and what percentage of negative CT findings is an acceptable counterpart to potential missed cases of occult injury is a topic of significant debate.1,2 The use of negative CT findings after trauma as a trigger for early hospital discharge has been shown to decrease hospital costs.3 In the current era, however, a missed injury after trauma is often regarded as a “never event.” Although CT imaging has become a highly reliable adjunct to a physical examination after trauma, concern remains regarding its sensitivity and specificity in detecting hollow viscus injury.4,5 Despite the growing number of patients with negative CT findings, it remains unclear at what point it is safe to clear these patients for hospital discharge. Given the sensitivity of physical examinations for posttraumatic intra-abdominal injury and of CT scans for solid organ injury, we hypothesized that a negative CT finding for an asymptomatic patient after blunt abdominal trauma is sufficient to exclude major intra-abdominal injury.

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