Interpreting the trauma ultrasound: Observations in 62 positive cases
- 31 Downloads
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
Unable to display preview. Download preview PDF.
- 4.Thal ER, Meyer DM. The evaluation of blunt trauma: computed tomography scan, lavage, or sonography. In: Cleveland M, Wolferth S, editors. Advances in trauma. Vol. 3 Chicago: Mosby-Year Book, 1988;201–28.Google Scholar
- 6.Hubbaard SG, Bivins BA, Sachatell CR et al Diagnostic errors with peritoneal lavage in patients with pelvic fractures. Arch Surg 1979;114:244–6.Google Scholar
- 8.Tiling, T, Bouillon B, Shmid A et al Ultrasound in blunt trauma. In: Border JF, Allgoewer M, Hansen ST et al. editors Blunt multiple trauma, New York: Marcel Dekker, 1990;415–33.Google Scholar
- 11.Kimura A, Otsulca T. Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study. J Trauma 1991;30:20–3.Google Scholar
- 12.Hoffman R, Nevlich M, Muggia-Sullum M, et al. Blunt abdominal trauma in multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma 1992;32:452–8.Google Scholar
- 15.Nerlich ML, Hoffman R. Ultrasonography in the diagnosis of abdominal trauma. In: Maull KI, editor. Advances in trauma and critical care. Vol. 6. Chicago: Mosby-Year Book, 1991;31–52.Google Scholar