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Operative versus nonoperative management of blunt abdominal trauma: Role of ultrasound-measured intraperitoneal fluid levels

      Abstract

      This study's objective was to analyze whether the quantity of free intraperitoneal fluid on ultrasonography, alone or in combination with unstable vital signs, is sensitive in determining the need for laparotomy in patients presenting with blunt trauma. Adult patients who presented with blunt abdominal trauma to 2 level I trauma centers were enrolled. Combined intraperitoneal fluid levels (anechoic stripe) of 5 intraperitoneal areas were measured and defined as small (< 1.0 cm), moderate (> 1.0 cm, < 3.0 cm), or large (> 3.0 cm). Unstable vital signs were defined as pulse > 100 bpm or systolic blood pressure < 90 mmHg. Exploratory laparotomy or computed tomography scan confirmed hemoperitoneum. Of 270 patients entered into the study, ultrasound detected free intraperitoneal fluid in 33 patients. Of the 18 patients with a large fluid accumulation, 16 underwent exploratory laparotomy (89% sensitivity), and all 8 patients with unstable vital signs underwent exploratory laparotomy (100% sensitivity). Of the 10 patients with a moderate fluid accumulation, 6 underwent exploratory laparotomy (60% sensitivity), and 4 of the 6 patients with unstable vital signs underwent exploratory laparotomy (67% sensitivity). A large intraperitoneal fluid accumulation on ultrasonography in combination with unstable vital signs, is sensitive for determining the need for exploratory laparotomy in patients presenting with blunt trauma. (Am J Emerg Med 2001;19:284-286. Copyright © 2001 by W.B. Saunders Company)

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      References

        • Rozycki GS
        • Ochsner MG
        • Jaffin JH
        • et al.
        Prospective evaluation of surgeons' use of ultrasound in the evaluation of the trauma patient.
        J Trauma. 1993; 34: 516-527
        • Rozycki GS
        • Ochsner MG
        • Schmidt JA
        • et al.
        A prospective study of surgeon-performed ultrasound as the primary adjunct modality for injured patient assessment.
        J Trauma. 1995; 39: 492-500
        • Ma OJ
        • Mateer JR
        • Ogata M
        • Kefer MP
        • et al.
        Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians.
        J Trauma. 1995; 38: 879-885
        • Ma OJ
        • Kefer MP
        • Mateer JR
        • et al.
        Evaluation of hemoperitoneum using a single, vs multiple-view ultrasonographic examination.
        Acad Emerg Med. 1995; 2: 581-586
        • Tso P
        • Rodriquez A
        • Cooper C
        • et al.
        Sonography in blunt abdominal trauma: A preliminary progress report.
        J Trauma. 1992; 33: 39-44
        • Lentz KA
        • McKenney MG
        • Nunez DB
        • et al.
        Evaluating blunt abdominal trauma: Role for ultrasonography.
        J Ultrasound Med. 1996; 15: 447-451
        • McElveen TS
        • Collin GR
        The role of ultrasonography in blunt abdominal trauma: A prospective study.
        Am Surg. 1997; 63: 184-188
        • Jehle D
        • Guarina J
        • Karamanoukian H
        Emergency department ultrasound in the evaluation of blunt abdominal trauma.
        Am J Emerg Med. 1993; 11: 342-346
        • Branney SW
        • Wolfe RE
        • Moore EE
        • et al.
        Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid.
        J Trauma. 1995; 39: 375-380
        • Tiling T
        • Bouillon B
        • Schmid A
        • et al.
        Ultrasound in blunt abdomino-thoracic trauma.
        in: Blunt Multiple Trauma: Comprehensive Pathophysiology and Care. Marcel Dekker, Inc, New York, NY1990: 415-433
        • Hoffman R
        • Nerlich M
        • Muggia-Sullam M
        • et al.
        Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography:A prospective analysis of 291 patients.
        J Trauma. 1992; 32: 452-458
        • Rothlin MA
        • Naf R
        • Amgwerd M
        • et al.
        Ultrasound in blunt abdominal and thoracic trauma.
        J Trauma. 1993; 34: 488-495
        • Liu M
        • Lee CH
        • P'eng FK
        Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning and ultrasonography for the diagnosis of blunt abdominal trauma.
        J Trauma. 1993; 35: 267-270
        • Branney SW
        • Moore EE
        • Cantrill S
        • et al.
        Ultrasound-based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma.
        J Trauma. 1997; 42: 1086-1090
        • Arrillaga A
        • Graham R
        • York JW
        • et al.
        Increased efficiency and cost-effectiveness in the evaluation of the blunt abdominal trauma patient with the use of ultrasound.
        Am Surg. 1999; 65: 31-35
        • Huang MS
        • Liu M
        • Wu JK
        • et al.
        Ultrasonography for the evaluation of hemoperitoneum during resuscitation: A simple scoring system.
        J Trauma. 1994; 36: 173-177
        • Porter RS
        • Nester BA
        • Dalsey WC
        • et al.
        Use of ultrasound to determine the need for laparotomy in trauma patients.
        Ann Emerg Med. 1997; 29: 323-330