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Abdominal Computed Tomography for the Diagnosis of Intra-abdominal Sepsis in Critically Injured Patients
Fishing in Murky Waters
George C. Velmahos, MD, PhD;
Eman Kamel, MD;
Thomas V. Berne, MD;
Nabil Yassa, MD;
Emily Ramicone, MS;
Zhenkai Song, MD;
Demetrios Demetriades, MD, PhD
Arch Surg. 1999;134:831-838.
Hypothesis Abdominal computed tomographic (ACT) scans are useful in the evaluation of sepsis of unknown origin in patients with major trauma.
Design Prospective case series of consecutive patients.
Setting Intensive care unit of level I academic trauma center.
Patients Eighty-five critically injured patients admitted to the intensive care unit in 32 months (6% of all intensive care unit admissions) who developed sepsis of unknown origin.
Interventions One hundred sixty-one ACT scans.
Main Outcome Measures Sensitivity and specificity of the ACT scans, number of patients subjected to changes in treatment following an ACT scan.
Results Forty-nine patients (58%) had an intra-abdominal focus of infection identified on ACT scan. Penetrating trauma and emergent laparotomy were the only independent factors associated with abnormal findings on ACT scan. The sensitivity and specificity of the test were 97.5% and 61.5%, respectively. Overall, 59 patients (69%) benefited from treatment changes after an ACT scan.
Conclusion Abdominal computed tomographic scans reliably identify intra-abdominal foci of infection in patients with major trauma evaluated for sepsis of unknown origin.
From the Department of Surgery, Division of Trauma and Critical Care (Drs Velmahos, Kamel, Berne, Song, and Demetriades), and the Departments of Radiology (Dr Yassa) and Biostatistics (Ms Ramicone), University of Southern California, Los Angeles.
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