Emergent Abdominal Sonography as a Screening Test in a New Diagnostic Algorithm for Blunt Trauma

TLDR

Emergent abdominal sonography (EAS) is of growing interest, yet its use in North America remains minimal. This study aimed to develop a new diagnostic algorithm for blunt abdominal injury by prospectively comparing EAS, diagnostic peritoneal lavage, and computed tomography. In a blinded study of 400 blunt trauma patients (mean ISS 26), EAS was performed first (positive indicating fluid, negative none) before DPL or CT, with 293 undergoing CT and 107 DPL. EAS averaged 2.6 min, was 94 % accurate for free fluid (PPV 82 %, NPV 96 %), missed only one immediate laparotomy case, and led to an algorithm that uses EAS as a rapid screening test with selective DPL and CT, supporting its routine use in blunt abdominal trauma.

Abstract

Although there is an interest in emergent abdominal sonography (EAS), the clinical utilization of EAS in North America is minimal. The purpose of this study was to develop a new diagnostic algorithm for blunt abdominal injury based on a prospective blinded comparison of EAS, diagnostic peritoneal lavage (DPL), and computed tomography (CT). EAS (+ = fluid, - = no fluid) was performed before the DPL or CT, in 400 patients with a mean Injury Severity Score of 26; 293 had a CT and 107 had a DPL. The EASs required 2.6 +/- 1.2 minutes with 82% less than or equal to 3 minutes. The accuracy of EAS for free fluid was 94% with a positive and negative predictive value of 82 and 96%, respectively. Only 1 of 338 patients with EAS- had an acute therapeutic laparotomy. Three patients with EAS- had a delayed laparotomy based on evolving clinical findings. The radiologists interpretation of the EAS video disagreed with the clinician sonographer in only 3% of cases. Based on these results, a diagnostic algorithm was developed using EAS as a screening test with selective use of DPL and CT. Emergent abdominal sonography performed by clinician sonographers is a rapid and accurate test for peritoneal fluid in blunt trauma victims, and the need for laparotomy in patients with a negative EAS is rare. Our study supports the routine use of EAS as a screening test in a diagnostic algorithm for the evaluation of blunt abdominal trauma.