Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma.

BACKGROUND In the assessment of blunt abdominal trauma, the reliability of ultrasonography (US) in identifying individual organ injuries remains uncertain, in spite of its usefulness in detecting hemoperitoneum. This study was designed to evaluate the overall diagnostic value of US, including identification of individual organ injuries. METHODS The accuracy of US in the detection of intra-abdominal injuries and the identification of individual organ injuries was evaluated in 1,239 patients seen during a 15-year period. Accuracy was based on detection of intraperitoneal fluid, free air, or irregular parenchymal lesions. RESULTS For the detection of injuries, US was 94.6% sensitive, 95.1% specific, and 94.9% accurate. Individual organ injuries were identified with sensitivities of 92.4, 90.0, 92.2, 71.4, and 34.7% for the liver, spleen, kidneys, pancreas, and intestine, respectively. CONCLUSION US is reliable for the detection of injuries and the identification of solid-organ injuries despite its poor sensitivity for intestinal injuries.

[1]  B. Boulanger,et al.  Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. , 1996, The Journal of trauma.

[2]  G. Casola,et al.  A prospective evaluation of abdominal ultrasound in blunt trauma: is it useful? , 1996, The Journal of trauma.

[3]  D. Nunez,et al.  1,000 consecutive ultrasounds for blunt abdominal trauma. , 1996, The Journal of trauma.

[4]  H. Pachter,et al.  The current status of nonoperative management of adult blunt hepatic injuries. , 1995, American journal of surgery.

[5]  A. Hagiwara,et al.  Early diagnosis of small intestine rupture from blunt abdominal trauma using computed tomography: significance of the streaky density within the mesentery. , 1995, The Journal of trauma.

[6]  D. Nunez,et al.  Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? , 1994, Journal of Trauma.

[7]  O. Goletti,et al.  The role of ultrasonography in blunt abdominal trauma: results in 250 consecutive cases. , 1994, The Journal of trauma.

[8]  D. Gens,et al.  Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. , 1992, AJR. American journal of roentgenology.

[9]  G. Regel,et al.  Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. , 1992, The Journal of trauma.

[10]  B. Boulanger,et al.  Sonography in blunt abdominal trauma: a preliminary progress report. , 1991, The Journal of trauma.

[11]  S. Cantrill,et al.  Diagnostic peritoneal lavage: accuracy in predicting necessary laparotomy following blunt and penetrating trauma. , 1990, The Journal of trauma.

[12]  T. Fabian,et al.  AAST organ injury scale: correlation of CT-graded liver injuries and operative findings. , 1990, The Journal of trauma.

[13]  E. Sloan,et al.  Diagnostic peritoneal lavage: is an isolated WBC count greater than or equal to 500/mm3 predictive of intra-abdominal injury requiring celiotomy in blunt trauma patients? , 1990, The Journal of trauma.

[14]  D. Jacobs,et al.  Peritoneal lavage white count: a reassessment. , 1990, The Journal of trauma.

[15]  M. Rothmund,et al.  Sonography versus peritoneal lavage in blunt abdominal trauma. , 1989, The Journal of trauma.

[16]  J. Weigelt,et al.  Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. , 1988, The Journal of trauma.

[17]  C. R. Patterson,et al.  A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma. , 1986, The Journal of trauma.

[18]  G. Shaftan,et al.  The diagnostic superiority of computerized tomography. , 1985, The Journal of trauma.

[19]  D. Alyono,et al.  Reappraisal of diagnostic peritoneal lavage criteria for operation in penetrating and blunt trauma. , 1982, Surgery.

[20]  A. V. van Vugt,et al.  Abdominal ultrasound as a reliable indicator for conclusive laparotomy in blunt abdominal trauma. , 1993, The Journal of trauma.

[21]  J. Meredith,et al.  Computed tomography and diagnostic peritoneal lavage. Complementary roles in blunt trauma. , 1992, The American surgeon.

[22]  P. Charlesworth,et al.  Diagnostic peritoneal lavage: integration with clinical information to improve diagnostic performance. , 1992, The Journal of trauma.

[23]  T. Otsuka,et al.  Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study. , 1991, The Journal of trauma.