Co-relation between clinical assessment, CT and intra-operative findings in emergency laparotomy. Is it time to rethink the algorithm?
Published Date: 01st September 2019
Publication Authors: Patnam V, Altaf K, Holdsworth J, Muttoni E, Rajaganeshan R
Aims
Although clinical diagnosis has essential value in an emergency setting, CT (computed tomography) has become the central tool of diagnosis to aid the need for emergency laparotomy. Delay in CT can often drastically alter the outcome, especially in patients over the age 60. We aimed to assess if initial clinical diagnosis and CT findings correlated to laparotomy findings and their impact on the postoperative course.
Method(s)
We included prospective data of 100 patients over the age of 60 who underwent emergency laparotomy at a district general hospital over a period of two years. Initial clinical diagnosis and CT scan results were compared to intra-operative laparotomy findings. Post-operative outcomes were assessed.
Result(s)
Median age (51 female and 49 male) was 65.5 years (IQR 60-89). Delay in admission and CT scan was 24 hours, and to laparotomy, after CT was 12 hours. Clinical diagnosis of 53% of patients matched with laparotomy findings, whereas CT did in 84%.With median ASA score of 3 (IQR 1-5), 53% required ITU/HDU admission with a median length of stay of 13 days, with mortality of 21%.
Conclusion(s)
High-risk patients over the age of 60 years had a significant chance of ITU/HDU admission and mortality. An accelerated assessment by CT scan, irrespective of clinical diagnosis in this set of patients can have better outcomes and post-operative course, including cost saving.
Patnam, V; Altaf, K; Holdsworth, J; Muttoni, E; Rajaganeshan, R. (2019). Co-relation between clinical assessment, CT and intra-operative findings in emergency laparotomy. Is it time to rethink the algorithm?. British Journal of Surgery. 106 (S5), 8