The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma.

introductionThis study aimed to assess the ability of contrast-enhanced computed tomography (CECT) to detect active abdominopelvic haemorrhage in patients with blunt trauma, as compared to digital subtraction angiography (DSA).

methodsIn this retrospective study, patients who underwent DSA within 24 hours following CECT for blunt abdominal and/or pelvic trauma were identified. The computed tomography (CT) trauma protocol consisted of a portal venous phase scan without CT angiography; delayed phase study was performed if appropriate. All selected CECT studies were independently reviewed for the presence of active extravasation of contrast by two radiologists, who were blinded to the DSA results. Fisher's exact test was used to correlate the presence of extravasation on CT with subsequent confirmed haemorrhage on DSA.

resultsDuring the eight-year study period, 51 patients underwent CECT prior to emergent DSA for abdominal or pelvic trauma. Evidence of active extravasation of contrast on CECT was observed in 35 patients and active haemorrhage was confirmed on DSA in 31 of these patients; embolisation was performed in all 31 patients. Two patients who were negative for active extravasation of contrast on CECT but positive for active haemorrhage on DSA had extensive bilateral pelvic fractures and haematomas. The sensitivity, specificity, and positive and negative predictive values of CECT in detecting active abdominopelvic haemorrhage, as compared to DSA, were 93.9%, 77.8%, 88.6% and 87.5%, respectively.

conclusionWhen compared with DSA, dual-phase CECT without CT angiography shows high sensitivity and positive predictive value for the detection of active haemorrhage in patients with blunt abdominopelvic trauma.