Oral contrast if immoblized?

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We no longer use oral contrast for emergency abdominal CT scanning
after blunt trauma.  The vast preponderance of the literature
concludes that oral contrast in this scenario does not improve
sensitivity or specificity for blunt intestinal or pancreatic
injuries;  in my institution (and I suspect in many others) contrast
administration delays the scan, and it may promote aspiration.

References below

Regards,

CM Ursic, MD
Trauma Services
St George Hospital
Sydney

Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH.
Computed tomographic scanning without oral contrast solution for blunt
bowel and mesenteric injuries in abdominal trauma. J Trauma. 2004
Feb;56(2):314-22.

Holmes JF, Offerman SR, Chang CH, Randel BE, Hahn DD, Frankovsky MJ,
Wisner DH. Performance of helical computed tomography without oral
contrast for the detection of gastrointestinal injuries.Ann Emerg Med.
2004 Jan;43(1):120-8.
Shankar KR, Lloyd DA, Kitteringham L, Carty HM.Oral contrast with
computed tomography in the evaluation of blunt abdominal trauma in
children. Br J Surg. 1999 Aug;86(8):1073-7.
 
Stafford RE, McGonigal MD, Weigelt JA, Johnson T. Oral contrast
solution and computed tomography for blunt abdominal trauma: a
randomized study. Arch Surg. 1999 Jun;134(6):622-6; discussion 626-7.
  
Tsang BD, Panacek EA, Brant WE, Wisner DH. Effect of oral contrast
administration for abdominal computed tomography in the evaluation of
acute blunt trauma. Ann Emerg Med. 1997 Jul;30(1):7-13.
  
Clancy TV, Ragozzino MW, Ramshaw D, Churchill MP, Covington DL,
Maxwell JG. Oral contrast is not necessary in the evaluation of blunt
abdominal trauma by computed tomography. Am J Surg. 1993
Dec;166(6):680-4; discussion 684-5.
Shreve WS, Knotts FB, Siders RW, Culler A, Fenn-Buderer N, Black C.
Retrospective analysis of the adequacy of oral contrast material for
computed tomography scans in trauma patients. Am J Surg. 1999
Jul;178(1):14-7.

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