Use of CT Tractography in anterior abdominal stab wounds
Date First Published:
February 1, 2018
Last Updated:
February 28, 2018
Report by:
Hannah Downing , Medical Student (Plymouth University,Derriford Hospital, Plymouth UK)
Search checked by:
Laura Cottey, Plymouth University,Derriford Hospital, Plymouth UK
Three-Part Question:
In [a patient with an anterior abdominal stab wound] does [CT tractography] reliably detect [intra-abdominal injury including peritoneal or hollow viscus perforation].
Clinical Scenario:
A 35-year-old male presents to the Emergency Department with an anterior abdominal stab wound (AASW). He is haemodynamically stable; you are unsure of the best method of investigation to detect significant intra-abdominal injury including hollow viscus perforation.
Search Strategy:
NICE Healthcare Databases (1985-2016) including: AMED, PubMED, BNI, EMBASE, HBE, HMIC, Medline, PsycINFO, CINAHL. Search terms included (anterior abdominal stab).ti,ab OR (abdominal stab investigations).ti,ab.
Search Details:
Outcome:
82 papers were found. Abstracts were reviewed for relevance of which 16 were duplicates and 64 were irrelevant. 2 papers were relevant and of sufficient quality and are included in this BET. Relevant papers are shown in the table below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Benefits of CT tractography in evaluation of anterior abdominal stab wounds. Ertan T, Sevim Y, Sarigoz T et al. 2015 United States | 20 haemodynamically stable patients with AASW. Patients with single and multiple stab wounds included. |
Case series / prospective observational study of new protocol | Detecting peritoneal penetration | Sensitivity 100%<br><br>Specificity 90% | Limited number of patients. No direct comparison with other methods e.g. CT alone |
| What is the diagnostic value of computed tomography tractography in patients with abdominal stab wounds?. Uzunosmanoglu H, Çorbacgiolu SK, Çevik Y et al. 2017 Germany | 73 patients with AASW. Managed with combined contrast abdominal enhanced CT scans and CT tractography, later undergoing laparotomy. Comparison with CT alone. |
Retrospective study | Detecting peritoneal penetration | Sensitivity 100%<br><br>Specificity 100%<br><br>PPV 100%<br><br>NPV 100%<br><br>Accuracy 100% | Unknown exclusion criteria. Patient stability unknown. |
Author Commentary:
This search revealed only one prospective observational study and one retrospective study with no randomised controlled trials comparing CT tractography to other methods of investigation (e.g. CT scanning or laparoscopy). Total patient numbers for the studies were small (total n=93).
The above studies suggest CT tractography is sensitive in identifying the need for laparotomy with specificity between 90-100%. Nonetheless, further research using clear patient selection is required before recommendation can be made regarding the utility of CT tractography as a routine diagnostic procedure.
The above studies suggest CT tractography is sensitive in identifying the need for laparotomy with specificity between 90-100%. Nonetheless, further research using clear patient selection is required before recommendation can be made regarding the utility of CT tractography as a routine diagnostic procedure.
Bottom Line:
Due to limited evidence as a result of only two studies and small patient numbers, further research is needed into the use of CT tractography as a diagnostic procedure. However the current reported sensitivity and specificity would suggest it could be a useful tool in the management of haemodynamically stable anterior abdominal stab wound patients.
References:
- Ertan T, Sevim Y, Sarigoz T et al.. Benefits of CT tractography in evaluation of anterior abdominal stab wounds.
- Uzunosmanoglu H, Çorbacgiolu SK, Çevik Y et al.. What is the diagnostic value of computed tomography tractography in patients with abdominal stab wounds?.