IMAGEM NO TRAUMA ABDOMINAL E NAS URGÊNCIAS CIRÚRGICAS: PROTOCOLOS DIAGNÓSTICOS E IMPACTO NA TOMADA DE DECISÃO
DOI:
https://doi.org/10.71248/zb7x5q67Palavras-chave:
Traumatismos abdominais, Diagnóstico por imagem, Ultrassonografia, Tomografia computadorizada, Tomada de decisão clínicaResumo
Esta revisão de escopo teve como objetivo mapear as evidências sobre a contribuição da ultrassonografia FAST/eFAST, da tomografia computadorizada e da radiografia na avaliação do trauma abdominal e das urgências cirúrgicas, considerando a precisão diagnóstica, os protocolos e o impacto na decisão terapêutica. Seguiram-se o método do Joanna Briggs Institute e o checklist PRISMA-ScR. A busca foi feita na MEDLINE, via PubMed (2021-2026), e incluiu revisões sistemáticas, diretrizes, ensaios randomizados e estudos multicêntricos ou de validação. Dos 200 registros, 30 foram incluídos. A FAST mostrou alta especificidade e sensibilidade limitada, sobretudo no trauma penetrante e em crianças. A ultrassonografia com contraste teve desempenho superior, e a FAST pré-hospitalar reduziu o tempo até a cirurgia. A tomografia contrastada foi a referência no paciente estável, com sensibilidade subótima para lesões de víscera oca e de diafragma e sem benefício do contraste entérico ou retal. Escores que combinam imagem e dados clínicos, como as regras PECARN, F-AST e FASILA, apoiaram a indicação de exames e de cirurgia. Persistem lacunas sobre a radiografia simples, as urgências não traumáticas e a realidade brasileira. Conclui-se que a imagem deve ser integrada a protocolos estruturados, ajustados ao estado hemodinâmico e aos recursos disponíveis.
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