2.50
Hdl Handle:
http://hdl.handle.net/10755/163050
Type:
Presentation
Title:
Oral Contrast in Trauma CT Scans of the Adult Blunt Trauma Patient
Abstract:
Oral Contrast in Trauma CT Scans of the Adult Blunt Trauma Patient
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Manion, Pat, RN, MS, CCRN, CEN
P.I. Institution Name:Genesys Regional Medical Center
Title:Trauma Program Manager
Contact Address:1 Genesys Parkway, Grand Blanc, MI, 48439, USA
Contact Telephone:(810) 606-7891
Purpose: Early in the 1980s, abdominal computerized tomographic (CT) scans with oral and intravenous
(IV) contrast became the diagnostic tool of choice to evaluate hemodynamically stable patients with blunt
abdominal trauma. IV contrast is used to identify intra-abdominal solid organ and vascular injury, whereas,
oral contrast can identify hollow viscous (stomach/small bowel lacerations/perforations) injury and help
define the mesentery. However, the use of oral contrast has not been consistent among trauma centers and
its effectiveness has been questioned. The purpose of this project was to evaluate if oral contrast is necessary
in CT scans to accurately diagnose the type of injury sustained by the blunt trauma patient.
Design/Setting: A prospective, descriptive design was used concerning the use of CT scans and oral contrast
for trauma service patients admitted through the emergency department between February 1, 2002
and December 30, 2003. The study was conducted in a midwestern, Level II trauma center.
Sample: There were 1596 trauma patients during this time. Of these, all 803 blunt trauma patients managed
by the trauma service were included. Patients with isolated orthopedic, hand, neurosurgical, or penetrating
injuries were not included in the study. The sample was 32% female, mean age was 35.9 years, 65%
were motor vehicle crashes, and mean Injury Severity Score (ISS) was 10. Eight trauma surgeons participated.
IRB approval was not required as chart abstraction of these patients was being performed concurrently
by the trauma coordinator for entry into the Trauma Registry.
Methodology: Use of contrast was left to physician discretion; there was no change in normal practice
patterns of determining CT necessity. The regularly used data collection form was completed with the
additional data point of oral contrast (yes/no). The final dictated CT scan report was reviewed for presence
of injury. The trauma coordinator followed the patient until discharge to ascertain if there were any physical
signs/symptoms or diagnostic tests that would reveal a missed injury from the first CT.
Results: Over the 23-month period, there were 803 trauma service patients. Clearing the abdomen without
CT was done in 347 patients. Abdominal CT scanning with oral contrast was performed in 44 patients,
and 412 had a CT scan with no oral contrast. All scans were performed with a GE Light-Speed-Scanner.
Injuries identified by CT were spleen (36), liver (16), kidney (6), and small bowel/mesenteric (9). Of these
67 CT-identified injuries, only one used oral contrast. No injuries were missed in this study population.
Conclusions: Oral contrast use in the blunt trauma population is not supported in the trauma/emergency
medicine literature. Sharing this literature and changing from a practice of always using oral contrast to
physician choice resulted in a decrease in oral contrast use by 89.4%. ED nurses (who were in the habit of
routinely giving contrast as part of the protocol) now needed to be informed of this potential change in
practice and reasons why the change was being made. In the early weeks of the study, some patients
received contrast before the physician had the opportunity to instruct the nurse otherwise. However, it
took only a few weeks before the nurses adapted to the change. Implications for further study would be a
comparison of the number of NG tubes inserted and the number of patients who vomit the contrast in a
patient population where the use of oral contrast is the norm versus a patient population where the use of
oral contrast is no longer the practice. [Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleOral Contrast in Trauma CT Scans of the Adult Blunt Trauma Patienten_GB
dc.identifier.urihttp://hdl.handle.net/10755/163050-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Oral Contrast in Trauma CT Scans of the Adult Blunt Trauma Patient</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Manion, Pat, RN, MS, CCRN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Genesys Regional Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Trauma Program Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1 Genesys Parkway, Grand Blanc, MI, 48439, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(810) 606-7891</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pmanion@chartermi.net</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Early in the 1980s, abdominal computerized tomographic (CT) scans with oral and intravenous<br/>(IV) contrast became the diagnostic tool of choice to evaluate hemodynamically stable patients with blunt<br/>abdominal trauma. IV contrast is used to identify intra-abdominal solid organ and vascular injury, whereas,<br/>oral contrast can identify hollow viscous (stomach/small bowel lacerations/perforations) injury and help<br/>define the mesentery. However, the use of oral contrast has not been consistent among trauma centers and<br/>its effectiveness has been questioned. The purpose of this project was to evaluate if oral contrast is necessary<br/>in CT scans to accurately diagnose the type of injury sustained by the blunt trauma patient.<br/>Design/Setting: A prospective, descriptive design was used concerning the use of CT scans and oral contrast<br/>for trauma service patients admitted through the emergency department between February 1, 2002<br/>and December 30, 2003. The study was conducted in a midwestern, Level II trauma center.<br/>Sample: There were 1596 trauma patients during this time. Of these, all 803 blunt trauma patients managed<br/>by the trauma service were included. Patients with isolated orthopedic, hand, neurosurgical, or penetrating<br/>injuries were not included in the study. The sample was 32% female, mean age was 35.9 years, 65%<br/>were motor vehicle crashes, and mean Injury Severity Score (ISS) was 10. Eight trauma surgeons participated.<br/>IRB approval was not required as chart abstraction of these patients was being performed concurrently<br/>by the trauma coordinator for entry into the Trauma Registry.<br/>Methodology: Use of contrast was left to physician discretion; there was no change in normal practice<br/>patterns of determining CT necessity. The regularly used data collection form was completed with the<br/>additional data point of oral contrast (yes/no). The final dictated CT scan report was reviewed for presence<br/>of injury. The trauma coordinator followed the patient until discharge to ascertain if there were any physical<br/>signs/symptoms or diagnostic tests that would reveal a missed injury from the first CT.<br/>Results: Over the 23-month period, there were 803 trauma service patients. Clearing the abdomen without<br/>CT was done in 347 patients. Abdominal CT scanning with oral contrast was performed in 44 patients,<br/>and 412 had a CT scan with no oral contrast. All scans were performed with a GE Light-Speed-Scanner.<br/>Injuries identified by CT were spleen (36), liver (16), kidney (6), and small bowel/mesenteric (9). Of these<br/>67 CT-identified injuries, only one used oral contrast. No injuries were missed in this study population.<br/>Conclusions: Oral contrast use in the blunt trauma population is not supported in the trauma/emergency<br/>medicine literature. Sharing this literature and changing from a practice of always using oral contrast to<br/>physician choice resulted in a decrease in oral contrast use by 89.4%. ED nurses (who were in the habit of<br/>routinely giving contrast as part of the protocol) now needed to be informed of this potential change in<br/>practice and reasons why the change was being made. In the early weeks of the study, some patients<br/>received contrast before the physician had the opportunity to instruct the nurse otherwise. However, it<br/>took only a few weeks before the nurses adapted to the change. Implications for further study would be a<br/>comparison of the number of NG tubes inserted and the number of patients who vomit the contrast in a<br/>patient population where the use of oral contrast is the norm versus a patient population where the use of<br/>oral contrast is no longer the practice. [Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:42Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:42Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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