Comparative evaluation of ultrasonography and CT in patients with abdominal trauma: A prospective study

Abstract

Objectives: To assess the relative role of US and CT in patients with abdominal trauma and to compare it with operative findings or clinical outcome and also to suggest guidelines for imaging and management protocols based on the above results. Materials and Methods: Thirty-three consecutive and positive patients of abdominal trauma were evaluated with both ultrasonography (US) and computed tomography (CT). Thirty-one of them had blunt abdominal trauma. One patient had penetrating injury and another patient had blast trauma. Injuries to different organs were staged using organ injury scaling (OIS) system. Hemoperitoneum as detected on US and CT was scored. The US and CT findings were compared and correlated with the operative findings or clinical follow-up in conservatively managed cases Results: Patients with large hemoperitoneum required surgery more often. Grading of organ injuries did not correlate with need for surgery except for splenic injuries. In 25 patients, either US or CT would have been sufficient for arriving at a management decision. In seven patients, CT altered the management decision that was arrived at on the basis of US. One patient required angiography for diagnosis and vascular intervention. Conclusions: CT is better than US for the diagnosis of abdominal trauma. However US can be used as a useful initial modality. It is important that in all patients where US indicated presence of abnormality, in suboptimal US studies and in US-negative studies in symptomatic patients, the studies be supplemented with CT. Truly normal US scans in asymptomatic patients may be highly reliable for excluding significant organ injuries and these patients may be followed up without CT scan or admission.