The value of abdominal computed tomography in patients presenting with trauma and in stage 1-2 hemorrhagic shock

The Value of Computerized Tomography of The Abdomen In Patients With Stage 1-2 Hemorrhagic Shock Applying With Trauma Introduction and Aim: Trauma is the leading cause of death in the world. In our country, it has an important place among the patient groups applying for emergency services. It constitutes an important group for death and disability situations in our country. In the management of trauma patients, imaging methods emerge as an important step in providing the location and early intervention of injuries. These methods appear as e-FAST, X-Ray, and CT imaging. In this study, the relationship between hemorrhagic shock status, e-FAST findings, and the factors affecting this relationship in trauma patients who presented to the emergency department and underwent pan-CT was evaluated. In this study, our primary aim is to determine whether abdominal tomography changes the management of the patient in trauma patients who are accepted as stage 1-2 hemorrhagic shock according to the ATLS hemorrhagic shock classification and whose E-FAST application is normal. Materials and Methods: This study was carried out retrospectively in the Emergency Service of Akdeniz University Faculty of Medicine with the permission of the Akdeniz University Faculty of Medicine Clinical Research Ethics Committee. Patients over the age of 18 who applied with trauma between September 01, 2021 and September 01, 2022 and underwent pan-CT in the emergency department were included in the study. E-FAST which was added to the hospital data system at the first admission by a radiologist or emergency medicine physcian and pan-CT results interpreted by the radiologist were recorded. The obtained data were analyzed. Results: In our study, 465 patients were followed, the mean age of the patients was 36.96±17.05. While 75.5% of these patients were male patients, 54.4% of 413 patients had a history of high-energy trauma. It was determined that 84.1% of the patients were in the stage 1-2 shock picture. It was determined that mortality developed in 3.9% of the patients and 3.6% of the patients underwent abdominal surgery. The rate of patients discharged from the emergency department was 44 38.1%. According to the abdominal CT findings, the sensitivity of the e-FAST scan was 28%, while the specificity was 97%. It was determined that there was no need for abdominal surgery in patients with stage 1-2 shock at the time of admission, with normal e-fast evaluation, if there was no penetrating injury, if abdominal pain did not continue, and if acute abdomen examination findings did not develop during follow-up. Conclusion: E-FAST is used as the first diagnostic method to detect the presence of intra-abdominal bleeding and injury in trauma patients admitted to the emergency department. While e-FAST application is an important diagnostic method for patients with abdominal trauma, the most important negative aspect is that it is user-dependent and retroperitoneally inadequate. In our study, it was observed that even if negative imaging was performed with e-FAST for patients with stage 1-2 hemorrhagic shock, abdominal CT imaging could yield positive results. However, even if the abdomen is CT positive, most of these patients were followed up and then discharged. The operated patients were groups of patients with abdominal penetrating injury or abdominal symptoms and physical examination findings. We recommend abdominal CT even if e-FAST is negative for abdominal penetrating injuries to patients with abdominal examination signs and symptoms that are considered low-grade shock. In the remaining low-stage shock group patients, the physician's decision will be determined. Keywords: e-FAST, Emergency Service, Computed Tomography, hemorrhagic shock