CT imaging signs of surgically proven bowel trauma
The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent w...
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description | The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105–111,
2014
). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings. |
doi_str_mv | 10.1007/s10140-016-1380-7 |
format | Article |
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2014
). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.</description><identifier>ISSN: 1070-3004</identifier><identifier>EISSN: 1438-1435</identifier><identifier>DOI: 10.1007/s10140-016-1380-7</identifier><identifier>PMID: 26873603</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Injuries - classification ; Abdominal Injuries - diagnostic imaging ; Abdominal Injuries - surgery ; Adolescent ; Aged, 80 and over ; Emergency Medicine ; Female ; Humans ; Imaging ; Intestines - diagnostic imaging ; Intestines - injuries ; Intestines - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Observer Variation ; Original Article ; Radiology ; Retrospective Studies ; Tomography, X-Ray Computed</subject><ispartof>Emergency radiology, 2016-06, Vol.23 (3), p.213-219</ispartof><rights>American Society of Emergency Radiology 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-525ad6caf35a930df431510bb62e3daa2fd970c4edbd45ae58b8d3e56b65720f3</citedby><cites>FETCH-LOGICAL-c372t-525ad6caf35a930df431510bb62e3daa2fd970c4edbd45ae58b8d3e56b65720f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10140-016-1380-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10140-016-1380-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26873603$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LeBedis, Christina A.</creatorcontrib><creatorcontrib>Anderson, Stephan W.</creatorcontrib><creatorcontrib>Bates, David D. B.</creatorcontrib><creatorcontrib>Khalil, Ramy</creatorcontrib><creatorcontrib>Matherly, David</creatorcontrib><creatorcontrib>Wing, Heidi</creatorcontrib><creatorcontrib>Burke, Peter A.</creatorcontrib><creatorcontrib>Soto, Jorge A.</creatorcontrib><title>CT imaging signs of surgically proven bowel trauma</title><title>Emergency radiology</title><addtitle>Emerg Radiol</addtitle><addtitle>Emerg Radiol</addtitle><description>The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105–111,
2014
). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.</description><subject>Abdominal Injuries - classification</subject><subject>Abdominal Injuries - diagnostic imaging</subject><subject>Abdominal Injuries - surgery</subject><subject>Adolescent</subject><subject>Aged, 80 and over</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>Intestines - diagnostic imaging</subject><subject>Intestines - injuries</subject><subject>Intestines - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>Original Article</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed</subject><issn>1070-3004</issn><issn>1438-1435</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kMtKAzEUhoMotlYfwI0MuHETPUkml1lKqRcouKnrkJlkhilzqUlH6dubOlVEcJME8p3_nPMhdEnglgDIu0CApICBCEyYAiyP0JSkTOF48OP4BgmYAaQTdBbCGgBEJtQpmlChJBPApojOV0ndmqruqiTUVReSvkzC4Ku6ME2zSza-f3ddkvcfrkm23gytOUcnpWmCuzjcM_T6sFjNn_Dy5fF5fr_EBZN0iznlxorClIybjIEtU0Y4gTwX1DFrDC1tJqFInc1tyo3jKleWOS5ywSWFks3QzZgbZ3gbXNjqtg6FaxrTuX4ImsgMMsrijhG9_oOu-8F3cbovisbOmYoUGanC9yF4V-qNj7v7nSag90L1KFRHoXovVMtYc3VIHvLW2Z-Kb4MRoCMQ4ldXOf-r9b-pn0dmfsU</recordid><startdate>20160601</startdate><enddate>20160601</enddate><creator>LeBedis, Christina A.</creator><creator>Anderson, Stephan W.</creator><creator>Bates, David D. B.</creator><creator>Khalil, Ramy</creator><creator>Matherly, David</creator><creator>Wing, Heidi</creator><creator>Burke, Peter A.</creator><creator>Soto, Jorge A.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160601</creationdate><title>CT imaging signs of surgically proven bowel trauma</title><author>LeBedis, Christina A. ; Anderson, Stephan W. ; Bates, David D. 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B.</creatorcontrib><creatorcontrib>Khalil, Ramy</creatorcontrib><creatorcontrib>Matherly, David</creatorcontrib><creatorcontrib>Wing, Heidi</creatorcontrib><creatorcontrib>Burke, Peter A.</creatorcontrib><creatorcontrib>Soto, Jorge A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LeBedis, Christina A.</au><au>Anderson, Stephan W.</au><au>Bates, David D. B.</au><au>Khalil, Ramy</au><au>Matherly, David</au><au>Wing, Heidi</au><au>Burke, Peter A.</au><au>Soto, Jorge A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT imaging signs of surgically proven bowel trauma</atitle><jtitle>Emergency radiology</jtitle><stitle>Emerg Radiol</stitle><addtitle>Emerg Radiol</addtitle><date>2016-06-01</date><risdate>2016</risdate><volume>23</volume><issue>3</issue><spage>213</spage><epage>219</epage><pages>213-219</pages><issn>1070-3004</issn><eissn>1438-1435</eissn><abstract>The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105–111,
2014
). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26873603</pmid><doi>10.1007/s10140-016-1380-7</doi><tpages>7</tpages></addata></record> |
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subjects | Abdominal Injuries - classification Abdominal Injuries - diagnostic imaging Abdominal Injuries - surgery Adolescent Aged, 80 and over Emergency Medicine Female Humans Imaging Intestines - diagnostic imaging Intestines - injuries Intestines - surgery Male Medicine Medicine & Public Health Middle Aged Observer Variation Original Article Radiology Retrospective Studies Tomography, X-Ray Computed |
title | CT imaging signs of surgically proven bowel trauma |
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