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Sonographic Patterns of Intraperitoneal Hemorrhage Associated With Blunt Splenic Injury

Division of Emergency Medicine (J.R.R., M.G.J., L.C.F.) and Department of Radiology (P.J.M., J.P.M.), University of California, Davis Medical Center, Sacramento, California USA.

Address correspondence and reprint requests to John R. Richards, MD, Division of Emergency Medicine, University of California, Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817 USA. E-mail: jrrichards{at}ucdavis.edu.

Objective. To determine the correlation between sonographic detection of free fluid in the left upper quadrant and blunt splenic injury. Methods. A retrospective review was conducted of all consecutive emergency blunt trauma sonograms obtained at a level I trauma center from January 1995 to January 2001. Data were collected on demographics, free fluid location, and patient outcome. Injuries were determined from computed tomography, diagnostic peritoneal lavage, laparotomy, or a combination thereof. Results. A total of 4320 blunt trauma sonograms were obtained, and 596 patients (14%) had intra-abdominal injuries. The mean age was 33.7 ± 19.1 years (range, 1–95 years), with 294 (49%) male and 302 (51%) female. There was no statistical difference between age, sex, or mechanism for all subgroups. There were 409 true-positive, 187 false-negative, 88 false-positive, and 3636 true-negative findings. Sensitivity of sonography for detecting all intra-abdominal injuries was 68%, and specificity was 97.6%; sensitivity for detecting isolated splenic injuries was 73.8%. Locations of free fluid in patients with nonsplenic injuries were compared with those in patients with splenic injuries. Isolated left upper quadrant free fluid was significantly associated with splenic injury (odds ratio = 3.0; P = .002), followed by diffuse free fluid (odds ratio = 2.1; P = .005). A subanalysis of isolated splenic injuries also revealed a significant association with left upper quadrant free fluid (odds ratio = 3.1; P = .007) and diffuse free fluid (odds ratio = 2.7; P = .0007). Conclusions. Free fluid in the left upper quadrant is significantly associated with splenic injury. This finding should triage patients more rapidly to computed tomography, angiography, embolization, and laparotomy.

Key Words: abdomen • focused abdominal sonography for trauma • injury • sonography • spleen • splenic

Abbreviations: CT, computed tomography • DPL, diagnostic peritoneal lavage • FAST, focused abdominal sonography for trauma • OR, odds ratio

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