Tomografia Axial Computada en Trauma Penetrante Absdominal por Arma Blanca

Un estudio prospectivo en un centro de trauma nivel 1 en EEUU analizó la utilidad del TAC en el trauma abdominal penetrante por arma blanca en paciente hemodinamicamente estable. Los autores reportan un valor predictivo negativo de 100%. A continuación el resumen:

Use of Computed Tomography in Anterior Abdominal Stab Wounds
Results of a Prospective Study
Ali Salim, MD; Burapat Sangthong, MD; Matthew Martin, MD; Carlos Brown, MD; David Plurad, MD; Kenji Inaba, MD; Peter Rhee, MD; Demetrios Demetriades, MD
Arch Surg. 2006;141:745-752.

Hypothesis Computed tomography (CT) can be used to evaluate patients with anterior abdominal stab wounds (AASWs).
Design Prospective observational study.
Setting Academic level I trauma center.
Patients and Methods All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.
Main Outcome Measures Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).
Results One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%.
Conclusions In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.