Interpreting the trauma ultrasound: Observations in 62 positive cases
The purpose of this study was to review all positive trauma abdominal ultrasound examinations, to determine a standard imaging protocol that would provide rapid patient evaluation, and to assess the ability of ultrasound to predict the need for emergent laparotomy.
All 62 positive examinations obtained over a 17-month period were reviewed. Nine anatomic sites were evaluated for free intraperitoneal fluid, recording the location and depth. A scoring system was devised to reflect the amount of fluid. Results were correlated with the need for laparotomy.
Free fluid was found in all nine areas; however, four areas (the right subphrenic, subhepatic, and perisplenic areas and the pelvis) were diagnostic when a positive examination resulted from fluid found in only one site. Eighteen parenchymal injuries were identified during sonography. To help determine the need for laparotomy, a simple scoring system was developed. Patients with a score of >2 were found to have a significantly higher incidence of requiring an operation (P<0.001).
We conclude that trauma ultrasonography should consist of imaging the right subphrenic, subhepatic, and perisplenic areas and the pelvis. Use of a scoring system can help determine the need for an operation
Key WordsTrauma ultrasound Free intraperitoneal fluid Blunt abdominal trauma
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