Comparative Study of Ultrasonography and Computed Tomography in the Evaluation of Blunt Abdominal Trauma at CMS-TH

Methods: A comparative study was performed at the College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan in the department of Radiodiagnosis, from January 2011 through July 2013. Where 150 patients following abdominal injuries were recorded, including patient age group, sex and mode of injury. Patient underwent USG and CT evaluation. The role of USG and CT was compared in the diagnosis of blunt abdominal trauma.


INTRODUCTION
Nepal facing the detrimental effect of the means of transportation because of its 1 death around the world resulting nearly 1.3 million death per year. 2 396 had serious accident. 3 Motor vehicle accidents are the most common cause of the blunt abdominal trauma (82.8%). 4 Early assessment of blunt abdominal trauma is essential to avoid preventable traumatic deaths. 5 Assessment of abdominal trauma was limited only to physical examination prior to Diagnostic Peritoneal Lavage,an invasive procedure carrying risk of visceral injury (0.6%). [6][7][8] This study is to compare the role of noninvasive imaging techniques (USG and CT) for assessing the patient with blunt abdominal trauma toaccurately identify the injuries that require prompt exploration and at the same time avoid unnecessary operative intervention that can be managed conservatively.

RESULTS
Of 150 patients included in the study there were 120 (80%) male with male: female ratio of 4:1. In this study 47 (31.3%) patients were considered free of intra-abdominal or associated organ injuries or both in CT and USG evaluation. 103 (68.70%) patients who or both were considered positive for blunt abdominal trauma where 82 (54.66%) patient were male and 21 (14%) patients were female. Most patients(60) with blunt abdominal injuries were in the age group 21-30 years ( Figure 1, Table 1).    (Table 2).  (Figure 3).

DISCUSSION
The main objective of this prospective study was to compare the role of the USG and CT scan accurately identify the injuries that requires prompt exploration and at the same time avoid unnecessary operative interventions that can be managed conservatively.
(80%) than female presented with blunt abdominal traumawhich is also the result of various studies. [7][8][9][10][11] This explained the outdoor nature of work among male who travels more in our part of world.
Blunt abdominal trauma was common among the students where 55 (53.39%) out of 103 were students and the common (72%). A similar studyshowed that vehicle accidents were the most common cause (62.8%) followed by falling from a height and interpersonal violence which was also the result of our study. 8 However, the in our study which is because of the location of our institute near the country's major highway. The use of automobile in this era is increasing in trend but due to factors like not vehicles condition, improper way of driving, driving in alcohol intoxication state has been responsible for number of accidents.
In the study, 95 (92.22%) patients out of 150 patient positive for abdominal injury had free where 15 patients with free intra-abdominal pancreatic injury. In a similar study among 275 patients following blunt abdominal injury, (13.7%) injuries were also seen which was not detected by our study. 9 This could explain the possible cause of intra-abdominal free In our study, out of 150 patients with blunt abdominal trauma 85.43% had organ injuries where spleen 47.72% was the most common organ to be injured followed by liver 32.95%, kidney 7.9%, multiple organs involvement 7.9% and pancreas 3.4%. Out of 88 patients with organ injuries 16 were not associated with free intra-abdominal showed CT evaluation of 257 patients with blunt abdominal injury where 212 revealed organ injuries with splenic injury (41%) being the most common followed by liver (41%), renal (18%), urinary bladder (6.6%) Spleen as common organ to be injured was also revealed in other studies. 10  In comparison to CT in evaluation of organ injury following blunt abdominal, USG revealed only 72 patients with organ injury that is, USG fail to reveal organ injury among 16 (18.18%) patients who were positive in CT. Out of 72 patient with organ injuries 38 (52.77%) had spleen injury followed by liver 23 (31.94%), kidney 4 (5.55%) and multiple organ injuries 7 (9.72%). Overall sensitivity, predictive value and accuracy of USG for organ injury were 81.81%, 100%, 100%, 79.48% and 89.33% respectively.

CONCLUSIONS
Abdominal Ultrasound and CT scan are useful in screening patients with blunt abdominal trauma to accurately identify the injuries that requires prompt exploration and at he same time avoid unnecessary operative interventions that can be managed conservatively. Blunt abdominal trauma cannot be excluded even if the patient has organ injury. CT is considered superior in assessment of patient with blunt abdominal injury.

CONFLICT OF INTEREST:
None.