Significant blunt bowel and mesenteric injury - Comparison of two CT scoring systems in a trauma registry cohort

Nathalie Keller; Tobias Zingg; Fabio Agri; Alban Denys; Jean-Francois Knebel; Sabine Schmidt

doi:10.1016/j.ejro.2021.100380

Significant blunt bowel and mesenteric injury - Comparison of two CT scoring systems in a trauma registry cohort

Eur J Radiol Open. 2021 Sep 30:8:100380. doi: 10.1016/j.ejro.2021.100380. eCollection 2021.

Authors

Nathalie Keller¹, Tobias Zingg², Fabio Agri², Alban Denys¹, Jean-Francois Knebel¹, Sabine Schmidt¹

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

Purpose: This study evaluated and compared two imaging-based scoring systems for the detection of significant blunt bowel and mesenteric injury (sBBMI) by emergency computed tomography (CT).

Methods and materials: We included all consecutive adult polytrauma patients admitted to our emergency department following a road traffic accident from January 2008 to June 2015, provided that intravenously contrast-enhanced whole-body CT examination was performed immediately after hospital admission. Two radiologists, blinded to patients' outcome, reviewed the CT examinations for distinctive direct intestinal or mesenteric vascular injury and indirect signs of abdominal injury. These findings were correlated with the patients' surgical or interventional radiology findings, autopsy, or clinical follow-up (>24 h). Two previously validated imaging-based bowel-injury scoring systems, the CT-based Faget score and the clinically and radiologically based Mc Nutt score (BIPS), were compared by applying each to our trauma cohort. Student t-test, chi-squared, and logistic regression were used in analyses.

Results: Twenty-one of 752 analysed patients (2.8 %) had confirmed sBBMI. Active mesenteric bleeding, mesenteric and free pneumoperitoneum, small haemoperitoneum, non-focal bowel wall thickening, mesenteric/pericolic fat stranding, and anterior abdominal wall injury were significantly correlated with sBBMI, as did the two evaluated scoring systems (p < 0.001). However, multivariate logistic regression revealed the superiority of the Faget score to the McNutt score.

Conclusion: The prevalence of sBBMI among polytrauma patients is low. Early diagnosis is necessary to avoid increased mortality. Certain CT features are pathognomic of sBBMI and must not be overlooked. Scoring systems are helpful, especially when they are based on radiological signs.

Keywords: AAWI, Anterior abdominal wall injury; AMB, Active mesenteric bleeding; ATMV, Abrupt termination of mesenteric vessels; BIPS, Bowel Injury Prediction Score; BWD, Bowel wall discontinuity; BWT, Bowel wall thickening; CT, Multidetector computed tomography; DBWE, Decreased bowel wall enhancement; FF, (Non-haematic) free fluid; FPP, Free pneumoperitoneum; HP, Haemoperitoneum; IBMV, Irregular beading of mesenteric vessels; Intestine, large; Intestine, small; MFS, Mesenteric (pericolic) fat stranding; MPP, Mesenteric pneumoperitoneum; Mesentery; Multidetector computed tomography; Polytrauma; SB, Small bowel; WBC, White blood cell; sBBMI, Significant blunt bowel and mesenteric injury.