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Journal of Ultrasound in Medicine, Vol 16, Issue 10 653-662, Copyright © 1997 by American Institute of Ultrasound in Medicine
Use of ultrasonography in the patient with acute abdominal trauma
J. P. McGahan, J. Rose, T. L. Coates, D. H. Wisner and P. Newberry
Department of Radiology, University of California, Davis, Medical Center, Sacramento 95817, USA.
The purpose of this study was to assess the use of ultrasonography in
patients with acute abdominal trauma. Five hundred prospective patients,
who came to the Emergency Department with acute trauma, were evaluated with
ultrasonography and included in this study. The ultrasonographic
examination focused on detection of free fluid but included evaluation of
parenchymal organs for injury. The physical examination was not used in the
statistical analysis of the sonographic findings. In comparing
ultrasonography to computed tomography, diagnostic peritoneal lavage, or
operative findings, we obtained 24 true positive, 79 true negative, four
false positive, and 14 false negative results. Sensitivity of
ultrasonography in detecting free fluid in comparison to computed
tomography, diagnostic peritoneal lavage, and surgery was 63%, specificity
was 95%, accuracy was 85%, positive predictive value was 86%, and negative
predictive value was 85%. The most common reason for false negative
sonographic results was identification of free fluid in the pelvis on
computed tomograms but not on ultrasonograms owing to lack of a full
bladder. In none of these instances were the sonographic false negative
results of clinical significance. Ultrasonography allowed detection of
solid organ injury of the liver in one of seven cases, of the kidney in one
of four cases, and in the bowel in zero of three cases. In the three
instances of bowel injury, free fluid was noted on ultrasonograms.
Ultrasonography fared better in cases of splenic laceration, permitting
detection in nine of 14 cases. The emergent ultrasonogram may be used to
detect free fluid in the abdomen of the acutely traumatized patient.
However, sonography is limited in detecting free fluid in the pelvis using
the present technique and does not allow visualization of organ injury.
Limitations of this examination should be recognized for appropriate triage
of the acutely traumatized patient.
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