256-slice CT scanners not reliable to diagnose traumatic diaphragmatic injuries
Level 1 trauma center surgeons at the University of Alabama at Birmingham Medical Center were hopeful that the capabilities of a new 256-slice computed tomography (CT) scanner could reduce the number of investigative surgeries they performed on patients with suspected traumatic diaphragmatic injuries. However, a retrospective study comparing the new scanner with clinical results determined that CT missed 40% of diaphragmatic injuries in patients between 2011 through 2017.
Published online November 26, 2018, in Trauma Surgery and Acute Care Open, the study reconfirmed the need for surgery to diagnose patients with suspected diaphragmatic injuries. The researchers reviewed CT scans of 1,068 patients who also underwent subsequent exploratory surgery. They identified 157 patients who had acute diaphragmatic injury. Most of these patients were men (80%) in their 30’s, with a single-sided (98%) penetrating (66%) injury. Half suffered a grade 3 injury based in Injury Severity Scores.
Principal investigator Parker Hu, MD, assistant professor of the Division of Acute Care Surgery, and colleagues determined that only 77 patients (47%) were accurately diagnosed by CT. The newer CT technology was an improvement, with the images of patients acquired from the 256-slice CT identifying 57% of the injuries compared to 46% with the 64-slice CT scanner. The 256-slice CT scanner was also better at identifying blunt injuries, which the authors attributed to “the inherent difficulty in radiographic diagnosis of what are often small lacerations.”
The authors acknowledge that their study is limited by the small patient cohort. However, they cited similar published studies that reached comparable conclusions.
“Most gunshot and stab wounds result in small lacerations of the diaphragm that are difficult to identify radiologically...,” they wrote. “Given that the 256-slice CT failed to identify over 40% of injuries, we think that intraoperative evaluation of the diaphragm must remain the gold standard for diagnosis in the setting of suspected diaphragmatic injury.”
REFERENCE
- Uhlich R, Kerby JD, Bosarge P, et al. Diagnosis of diaphragm injuries using modern 256-slice CT scanners: too early to abandon operative exploration. Trauma Surg Acute Care Open. Published online November 26, 2018. 3(1):e000251. doi: 10.1136/tsaco-2018-000251.