Comparison of Pre-operative Ct Scan and Laparotomy Findings in Adult Patients With Blunt Abdominal Trauma at Kenyatta National Hospital: a Comparative Cross-sectional Study.

Abstract

Background: The abdomen contains vital organs such as the liver, spleen, kidneys, and intestines, which are susceptible to injury in blunt trauma incidents such as motor vehicle accidents, falls, or assaults. The forceful impact or compression of the abdomen can result in various injuries, including organ lacerations, contusions, fractures, and internal bleeding. The outcome is dependent on the availability and proper use of imaging modalities. CT imaging is the preferred diagnostic tool for evaluating hemodynamically stable patients. Objective: To compare Pre-operative CT scan findings with Laparotomy findings in adult patients with blunt abdominal trauma at Kenyatta National Hospital. Methods: This was a comparative cross-sectional study on a sample size of 148 patients with blunt abdominal trauma presenting at Kenyatta National Hospital. Data was retrieved from the Medical Records of patients presenting at the Hospital with a diagnosis of blunt abdominal injury, from January 2020 to December 2021. This duration allows the researcher to determine a good sample size with which to draw an adequate conclusion to meet both the broad and specific objectives. The data obtained was recorded in a data extraction tool. Data collected was put in an excel sheet and then transferred for analysis in SPSS 26.0 and sensitivity and specificity indices was determined. The data was then be summarized and presented as frequencies, proportions, and percentages, in tables and graphs. Results: A total of 136 patients were enrolled into the study. The mean age was 29.7(SD±12.5) years with 64.7% (n =88) of the patients aged between 18 and 35 years. Majority of the patients 83.1% (n =113) were male and 56.6% (n =77) were married, 75.7% (n =104) of the patients with blunt abdominal trauma were due to motor vehicle collisions. The CT findings showed that 57.4% (n =78) had hemoperitoneum, 39% (n =53) of the patients had splenic injury, 36% (n =49) had kidney injury and Urinary Tract Injury, 28.7% (n =39) had liver injury and 13.2% (n = 18) had bowel injury. The laparotomy findings established that 61.8%(n =84) had hemoperitoneum, 38.2% (n =52) had splenic injury, 33.8%(n =46) had kidney injury and Urinary Tract Injuries, 27.2%(n =37) had liver injury while 14.7%(n =20) had bowel and mesenteric injuries. Splenic injury, liver injury, and pancreatic injury all had 100% sensitivity and specificity of 98.8%, 98.1%, and 100%, respectively. However only 1 case of pancreatic injury was evident from the sample size and this was not enough to draw a conclusion. The accuracy of CT in predicting splenic and diaphragm intra-operative findings was 99.3%, with liver injury at 98.5%. Conclusion and recommendations: The study recommends a multimodal approach to managing blunt abdominal trauma, combining clinical evaluation, imaging studies like CT xv scans, and sometimes exploratory laparoscopy or laparotomy to effectively identify and address injuries. CT scans should be prioritized in hemodynamically stable patients to accurately assess the extent of injuries, particularly to the spleen, liver, pancreas, and diaphragm, before considering surgical interventions. This approach coupled with efficient patient selection helps reduces unwarranted surgical interventions as it is associated with high morbidity, significant complications and prolonged length of hospital stay. This has been shown to decrease healthcare costs in our set-up where financial constraints remain a challenge, improving patient outcomes and satisfaction, optimizing healthcare resources and alignment with practicing evidence-based medicine