Emerg Med J 30:e14 doi:10.1136/emermed-2011-200376
  • Electronic pages

Sensitivity and specificity of CT scan and angiogram for ongoing internal bleeding following torso trauma

  1. Rajiv Biswal4
  1. 1Department of Surgery, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, USA
  2. 2Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey, USA
  3. 3Department of Research, Jersey Shore University Medical Center, Neptune, New Jersey, USA
  4. 4Department of Radiology, Jersey Shore University Medical Center, Neptune, New Jersey, USA
  1. Correspondence to Dr Nasim Ahmed, Clinical Associate Professor of Surgery UMDNJ, Department of Surgery, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, 1945 State Route. 33, Neptune, NJ 07754, USA; nahmed{at}
  1. Contributors All authors including coauthors have contributed in different capacity to study design, data collection and analysis and writing of the manuscript.

  • Accepted 5 March 2012
  • Published Online First 13 April 2012


Background Occult internal bleeding in the trauma patient which remains undiagnosed and unaddressed has the potential to result in morbidity or mortality. Advancements in CT and angiography have played an integral role in the management of this patient population.

Objective The purpose of the study was to identify the sensitivity and specificity of CT scan and angiography in detecting ongoing internal bleeding.

Methods Consecutive patients who sustained torso trauma and subsequently underwent CT scan and angiography were included in this study. Data reviewed included clinical information, CT scan and angiography readings. Extravasations of contrast from CT scan and/or angiogram were considered positive for ongoing internal bleeding.

Results From January 2002 through July 2007, 113 adult trauma patients sustaining torso trauma underwent CT scan of chest or abdomen followed by angiography. Sixty-six patients were negative for extravasation from either of the tests. Twenty-four of 35 patients had both positive CT scans and angiograms. Eleven patients with positive CT scans did not have bleeding on angiogram. Similarly, 12 out of 36 patients with positive angiograms did not show any extravasation of contrast on CT scan. Both modalities had a specificity of 100% based on clinical definition. The sensitivities of CT scan and angiogram were 74.5% and 76.6%, respectively. They were not significantly different (p=0.95). The negative predictive values for CT and angiogram were 84.6% and 85.7%. They were not significantly different (p=0.95) either. When CT scan was used alone, 25.5% of bleeding patients were missed.

Conclusions The sensitivity of CT scan and angiography at detecting ongoing bleeding was around 75% across the torso injury spectrum.


  • Paper was presented at the 94th Annual Clinical Congress, American College of Surgeon (paper session; Trauma and Critical Care II) 12–16 October 2008.

  • Competing interests None.

  • Patient consent Retrospective review of the existing data. Waiver of the consent was approved by the IRB.

  • Ethics approval Ethics approval was provided by Institutional Review Board (IRB).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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