Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort
Purpose: This study evaluated and compared two imaging-based scoring systems for the detection of significant blunt bowel and mesenteric injury (sBBMI) by emergency computed tomography (CT) Methods and Materials: We included all consecutive adult polytrauma patients admitted to our emergency departm...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-01-01
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| Series: | European Journal of Radiology Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352047721000605 |
| _version_ | 1819174552485232640 |
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| author | Nathalie Keller Tobias Zingg Fabio Agri Alban Denys Jean-Francois Knebel Sabine Schmidt |
| author_facet | Nathalie Keller Tobias Zingg Fabio Agri Alban Denys Jean-Francois Knebel Sabine Schmidt |
| author_sort | Nathalie Keller |
| collection | DOAJ |
| description | Purpose: This study evaluated and compared two imaging-based scoring systems for the detection of significant blunt bowel and mesenteric injury (sBBMI) by emergency computed tomography (CT) Methods and Materials: We included all consecutive adult polytrauma patients admitted to our emergency department following a road traffic accident from January 2008 to June 2015, provided that intravenously contrast-enhanced whole-body CT examination was performed immediately after hospital admission. Two radiologists, blinded to patients’ outcome, reviewed the CT examinations for distinctive direct intestinal or mesenteric vascular injury and indirect signs of abdominal injury. These findings were correlated with the patients’ surgical or interventional radiology findings, autopsy, or clinical follow-up (>24 h). Two previously validated imaging-based bowel-injury scoring systems, the CT-based Faget score and the clinically and radiologically based Mc Nutt score (BIPS), were compared by applying each to our trauma cohort. Student t-test, chi-squared, and logistic regression were used in analyses. Results: Twenty-one of 752 analysed patients (2.8 %) had confirmed sBBMI. Active mesenteric bleeding, mesenteric and free pneumoperitoneum, small haemoperitoneum, non-focal bowel wall thickening, mesenteric/pericolic fat stranding, and anterior abdominal wall injury were significantly correlated with sBBMI, as did the two evaluated scoring systems (p < 0.001). However, multivariate logistic regression revealed the superiority of the Faget score to the McNutt score. Conclusion: The prevalence of sBBMI among polytrauma patients is low. Early diagnosis is necessary to avoid increased mortality. Certain CT features are pathognomic of sBBMI and must not be overlooked. Scoring systems are helpful, especially when they are based on radiological signs. |
| first_indexed | 2024-12-22T20:40:47Z |
| format | Article |
| id | doaj.art-4ad07fd7ee03475da4c4b3c0a1e2ad74 |
| institution | Directory Open Access Journal |
| issn | 2352-0477 |
| language | English |
| last_indexed | 2024-12-22T20:40:47Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Radiology Open |
| spelling | doaj.art-4ad07fd7ee03475da4c4b3c0a1e2ad742022-12-21T18:13:20ZengElsevierEuropean Journal of Radiology Open2352-04772021-01-018100380Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohortNathalie Keller0Tobias Zingg1Fabio Agri2Alban Denys3Jean-Francois Knebel4Sabine Schmidt5Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Corresponding author at: Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.Purpose: This study evaluated and compared two imaging-based scoring systems for the detection of significant blunt bowel and mesenteric injury (sBBMI) by emergency computed tomography (CT) Methods and Materials: We included all consecutive adult polytrauma patients admitted to our emergency department following a road traffic accident from January 2008 to June 2015, provided that intravenously contrast-enhanced whole-body CT examination was performed immediately after hospital admission. Two radiologists, blinded to patients’ outcome, reviewed the CT examinations for distinctive direct intestinal or mesenteric vascular injury and indirect signs of abdominal injury. These findings were correlated with the patients’ surgical or interventional radiology findings, autopsy, or clinical follow-up (>24 h). Two previously validated imaging-based bowel-injury scoring systems, the CT-based Faget score and the clinically and radiologically based Mc Nutt score (BIPS), were compared by applying each to our trauma cohort. Student t-test, chi-squared, and logistic regression were used in analyses. Results: Twenty-one of 752 analysed patients (2.8 %) had confirmed sBBMI. Active mesenteric bleeding, mesenteric and free pneumoperitoneum, small haemoperitoneum, non-focal bowel wall thickening, mesenteric/pericolic fat stranding, and anterior abdominal wall injury were significantly correlated with sBBMI, as did the two evaluated scoring systems (p < 0.001). However, multivariate logistic regression revealed the superiority of the Faget score to the McNutt score. Conclusion: The prevalence of sBBMI among polytrauma patients is low. Early diagnosis is necessary to avoid increased mortality. Certain CT features are pathognomic of sBBMI and must not be overlooked. Scoring systems are helpful, especially when they are based on radiological signs.http://www.sciencedirect.com/science/article/pii/S2352047721000605PolytraumaMultidetector computed tomographyMesenteryIntestine, smallIntestine, large |
| spellingShingle | Nathalie Keller Tobias Zingg Fabio Agri Alban Denys Jean-Francois Knebel Sabine Schmidt Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort European Journal of Radiology Open Polytrauma Multidetector computed tomography Mesentery Intestine, small Intestine, large |
| title | Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort |
| title_full | Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort |
| title_fullStr | Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort |
| title_full_unstemmed | Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort |
| title_short | Significant blunt bowel and mesenteric injury – Comparison of two CT scoring systems in a trauma registry cohort |
| title_sort | significant blunt bowel and mesenteric injury comparison of two ct scoring systems in a trauma registry cohort |
| topic | Polytrauma Multidetector computed tomography Mesentery Intestine, small Intestine, large |
| url | http://www.sciencedirect.com/science/article/pii/S2352047721000605 |
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