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Martin A. Schreiber, MD; Larry M. Gentilello, MD; Peter Rhee, MD, MPH; Gregory J. Jurkovich, MD; Ronald V. Maier, MD

Arch Surg. 1996;131(9):954-959.

Abstract
Objective
To determine if computed tomographic (CT) scanning can be used to identify patients with blunt trauma, positive results of diagnostic peritoneal lavage (DPL), and a stable hemodynamic status who could be managed safely and cost-effectively without celiotomy.

Design
Patients with blunt trauma who required an abdominal evaluation underwent DPL. Patients with a red blood cell count greater than 10¹¹/L (10⁵/mm³) on lavage then underwent CT. Patients with solid organ injury alone, as detected on CT scan, were observed; those with evidence of hollow viscus injury underwent celiotomy.

Results
Sixty-seven hemodynamically stable patients had a red blood cell count greater than 10¹¹/L on DPL; 38 patients underwent subsequent CT scanning, and 29 underwent immediate celiotomy in violation of the protocol. Eleven patients in the protocol group ultimately underwent celiotomy. Overall, there were significantly fewer nontherapeutic celiotomies performed in the protocol group (2/38 vs 9/29, P<.01). There were no deaths in either group. Because DPL is less expensive than CT, limiting CT to patients with DPL-positive results and hemodynamic stability reduced the charges associated with abdominal evaluation by $580 594 over a period of 2 years.

Conclusion
Limiting CT to the evaluation of patients with DPL-positive results and hemodynamic stability is safe, reduces charges, and results in a lower rate of nontherapeutic celiotomies compared with DPL alone.

Arch Surg. 1996;131:954-959

Author Affiliations
From the Department of Surgery, Harborview Medical Center, Seattle, Wash.

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