Ultrasound Evaluation of Blunt Abdominal Trauma
Bruce ThomasRobert E. FalconeDonald G. VasquezSteven A. SantanelloMichael C. TownsendScott HockenberryJeffrey InnesSTEVEN R. WANAMAKER
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Abstract:
Objective Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established. Design This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement. Materials and Methods All trauma surgeons attended a combined didactic and "hands on" 8-hour trauma US course. Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation. Measurements and Main Results Three hundred patients were studied over a 4-month period. They averaged 35 years of age with an average injury severity score of 12. The time required to perform the US examination averaged less than 3 minutes. Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%). US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%. Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00. Conclusions This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.Keywords:
Diagnostic peritoneal lavage
Credentialing
Blunt trauma
Exploratory laparotomy
Polytrauma
Diagnostic peritoneal lavage
Blunt trauma
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Exploratory laparotomy
Diagnostic peritoneal lavage
Blunt trauma
Trauma Center
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Citations (126)
Evaluation of blunt abdominal trauma is clinically challenging. Diagnostic peritoneal lavage (DPL) and computed tomographic (CT) scanning have become primary diagnostic modalities. We examined the efficacy and role of ultrasonographic (US) studies in the initial abdominal evaluation of blunt trauma patients. Over an 8-month period, patients whose abdominal work-up indicated the need for DPL or CT were evaluated sonographically within the first hour after admission by trauma fellows (PGY-6) with at least 1 hour of theoretical training and 1 hour of practical training. Sonograms considered positive were those showing free peritoneal fluid or organ disruption. Hard copies of the sonograms were evaluated by a staff radiologist without knowledge of the fellows' interpretations or of DPL or CT results. Based on the fellows' interpretation of the real-time sonograms, among the first 163 patients studied were 11 true-positive, 146 true-negative, one false-positive, and five false-negative results. Sixteen patients had intra-abdominal injury documented by DPL, CT, or laparotomy. Ultrasonography was 91% sensitive in detecting the presence of hemoperitoneum. Overall, ultrasonography was 69% sensitive, 99% specific, and 96% accurate in diagnosing abdominal injury. We conclude that emergency sonography on admission can serve as a valuable adjunct to the physical diagnosis of clinically significant hemoperitoneum. It is noninvasive, portable, and accurate in determining the need for further diagnostic/surgical intervention.
Hemoperitoneum
Diagnostic peritoneal lavage
Blunt trauma
Abdominal ultrasonography
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Hemoperitoneum
Diagnostic peritoneal lavage
Blunt trauma
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Citations (20)
The evaluation of blunt abdominal trauma (BAT) can be difficult because of the subtle manifestations of the injuries and because assessment is hampered by altered neurologic status. Short of laparotomy, CT and diagnostic peritoneal lavage provided the best means of accurately diagnosing intra-abdominal injury. Ultrasound (US) has recently been introduced into trauma centers in the United States as a quick, cheap, and safe method to make the diagnosis of BAT. After theoretical and practical training, one attending surgeon and one chief resident began performing trauma ultrasounds at a rural, Level 1 trauma center. The US was performed concurrent with initial resuscitation and prior to other studies. The US was then correlated with the other tests. Of the 82 tests performed, 79 correlated with other methods of diagnosis. Overall, US was 88 per cent sensitive, 98 per cent specific, and 96 per cent accurate in diagnosing intra-abdominal injuries. There were no operative sequelae to patients whose injury was missed by US. We conclude that: 1) US can be used as the initial method of diagnosis of BAT and 2) surgeons are able to perform the examination accurately.
Diagnostic peritoneal lavage
Trauma Center
Blunt trauma
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Diagnostic peritoneal lavage
Blunt trauma
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Citations (6)
Background/Objective: Patients in unstable clinical conditions with blunt abdominal trauma require rapid evaluation of the abdominal organ injury to assess the need for laparatomy. This prospective study was conducted to determine the use of emergency sonography for evaluating patients with blunt abdominal trauma and to compare the accuracy of sonography with the results of diagnostic peritoneal lavage (DPL), exploratory laparatomy and CT scan. Patients and Methods: Emergency sonography was performed prior to any of the diagnostic methods, peritoneal lavage, exploratory laparatomy and CT, on 204 patients with blunt abdominal trauma. Sonography was performed with the “focused abdominal sonography for trauma” (FAST) technique and six areas of the abdomen were examined to detect free peritoneal fluid. Results: Sonography showed a sensitivity of 95.4%, specificity of 78.4% and an overall accuracy of 89% in the diagnosis of free peritoneal fluid. The positive and negative predictive values of sonography were 89.2% and 90.6%, respectively. Conclusion: Sonography is a reliable and accurate method for the emergency evaluation of blunt abdominal trauma.
Diagnostic peritoneal lavage
Exploratory laparotomy
Blunt trauma
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Objective Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established. Design This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement. Materials and Methods All trauma surgeons attended a combined didactic and "hands on" 8-hour trauma US course. Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation. Measurements and Main Results Three hundred patients were studied over a 4-month period. They averaged 35 years of age with an average injury severity score of 12. The time required to perform the US examination averaged less than 3 minutes. Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%). US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%. Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00. Conclusions This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.
Diagnostic peritoneal lavage
Credentialing
Blunt trauma
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Citations (168)
Objective: To identify the performance of Focused Assessment Sonography in Trauma (FAST) in detecting hemoperitoneum in blunt abdominal trauma patients at the emergency room. Meterials and methods: The diagnostic results of blunt abdominal trauma patients assessed using the FAST in the emergency room of Songklanagarind Hospital during 1 January 2008 and 30 June 2008 were compared with the diagnostic results of abdominal computed tomography (CT) scans, diagnostic peritoneal lavage (DPL), exploratory laparotomies and discharge results. Sensitivity, specificity and accuracy were calculated. Result: There were 999 traumatic patients during the 6-month study period. FAST was performed in 291 patients (29.0%) with a mean age of 34.6 ฑ 15.3 years, 227 men (78.0 %) and 64 women (22.0%). The most common injuries were motorcycle accident (61.9%), car accident (19.9%) and falls (6.5%). The FAST results were positive in 18 patients. FAST had a sensitivity of 54.8 %, a specificity of 99.6 %, an accuracy of 94.8%. Conclusion: FAST examination had limitation for screening hemoperitoneum in blunt abdominal trauma patients. The positive result is reliable in detecting intra-abdominal free fluid. In cases of negative result, it could not exclude intra-abdominal free fluid and should be follow by serial abdominal examination or confirmatory tests such as CT abdomen or DPL.
Hemoperitoneum
Diagnostic peritoneal lavage
Blunt trauma
Exploratory laparotomy
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Citations (0)
Background: Assessment of patients in the emergency department who sustain blunt abdominal trauma represents a significant diagnostic challenge. Computed tomography (CT) is increasingly used as the principal investigation for these patients. A sensitive screening test could safely reduce the use of CT. Objectives: To appraise the evidence supporting the use of diagnostic peritoneal lavage and focused abdominal sonography for trauma as screening tests in the emergency department to reduce the use of CT in the initial assessment of patients sustaining blunt abdominal trauma. Methods: A search of high-quality evidence resources was performed, followed by a hand search of the bibliographies of all relevant articles. Results: Altogether, 55 articles were found during the initial search, of which 23 were relevant. An additional 11 were found by hand searching. Six relevant original research articles were found. Conclusion: Screening diagnostic peritoneal lavage and selective CT is a safe diagnostic strategy for the investigation of blunt abdominal trauma. Further research is needed to determine the role of focused abdominal sonography for trauma scanning in diagnostic protocols.
Diagnostic peritoneal lavage
Blunt trauma
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Citations (48)