A Prospective Study of Emergent Abdominal Sonography after Blunt Trauma

Boulanger, Bernard R.; Brenneman, Frederick D.; McLellan, Bruce N.; Rizoli, Sandro; Culhane, John; Hamilton, Paul

doi:10.1097/00005373-199508000-00022

Cited by 125 publications

(33 citation statements)

References 18 publications

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“…Ultrasound Ultrasound is a rapid, portable, and reliable method for screening of patients with sustained abdominal trauma for the presence of hemoperitoneum [13,15,16,17,27]. Emergency sonography for trauma is performed bedside and simultaneously with physical assessment, resuscitation, and stabilization within the first minutes of the patient's arrival.…”

Section: Imaging Strategies In Patients With Abdominal and Pelvic Traumamentioning

confidence: 99%

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Traumatic injuries: imaging of abdominal and pelvic injuries

et al. 2002

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The availability of new imaging modalities has altered the diagnostic approach to patients with abdominal and pelvic trauma. Computed tomography and ultrasound have largely replaced diagnostic peritoneal lavage. Ultrasound is used in most trauma centers as the initial imaging technique for the detection of hemoperitoneum and helps to determine the need for emergency laparotomy. Computed tomography allows for an accurate diagnosis of a wide range of traumatic abdominal and pelvic conditions. The speed of single-detector helical and multi-detector row CT (MDCT) permits a rapid CT examination of the seriously ill patient in the emergency room. In particular, the technology of MDCT permits multiple, sequential CT scans to be quickly obtained in the same patient, which is a great advance in the rapid assessment of the multiple-injured patient. The evolving concepts in trauma care promoting non-operative management of liver and splenic injuries creates the need for follow-up cross-sectional imaging studies in these patients. Computed tomography and, less frequently, MR or ultrasound, are used for this purpose.

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Section: Imaging Strategies In Patients With Abdominal and Pelvic Traumamentioning

confidence: 99%

“…Several studies have shown that in the hands of an experienced operator, US allows detection of free intraperitoneal fluid with a very high accuracy [12,13,14,15,16,17]. Most trauma surgeons rely on CT as the next diagnostic step for this secondary evaluation of the hemodynamically stable patient with suspected abdominal injury.…”

Section: Introductionmentioning

confidence: 99%

Traumatic injuries: imaging of abdominal and pelvic injuries

et al. 2002

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“…The sensitivity of US for the detection of free intraperitoneal fluid is generally considered to be excellent, and there is general consensus that abdominal US is more cost-effective than diagnostic peritoneal lavage (DPL) [7]. Although DPL has a high false-positive rate, US has a good overall specificity to suggest an intra-abdominal injury [8,9,10]; thus, there is general consensus that in a victim of polytrauma who is hemodynamically unstable at admission, the presence of a major quantity of free intraperitoneal fluid on US in a hemodynamically unstable polytrauma warrants emergency laparotomy.…”

Section: Ultrasonographymentioning

confidence: 99%

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

et al. 2002

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Abdominal US and CT play an important role in the initial management of blunt trauma in adults. Ultrasound is an excellent method for detection of free intra-abdominal fluid. It is the modality of choice for initial screening and enables selection of hemodynamically unstable trauma victims with severe hemoperitoneum for immediate surgery. However, even in experienced hands, US is not sufficient to rule out organ injuries reliably. Computed tomography, and particularly multislice CT (MSCT), has several major advantages over US and is currently unsurpassed for the detection of blunt visceral injuries in the abdomen. Computed tomography has a high sensitivity for the detection of parenchymal splenic and hepatic injuries. Injuries of the gastrointestinal tract may be detected with good sensitivity provided that adequate examination technique and careful diagnostic interpretation are combined. The value of CT-based injury-grading systems for predicting the outcome of conservative treatment remains unproven; however, demonstration of direct vascular injuries with CT, e.g., the intrasplenic "contrast blush" sign, may indicate a high likelihood that conservative treatment will fail, thus warranting angiographic embolization or surgery. Monitoring of conservatively treated trauma victims by means of repeat CT studies enables early detection of a variety of delayed, clinically silent complications of trauma, e.g., posttraumatic biloma or bowel devascularization. Catheter angiography may be reserved to selected cases with vascular injuries proven on CT.

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“…It is after all an impressively rapid technique (< 3 min) providing almost instant information, particularly in the patient with a large hemoperitoneum. The literature describes a specificity, sensitivity and accuracy for free fluid ranging from 98% to 100%, 81% to 92% and 96% to 99%, respectively [41,46,48,62,[64][65][66][67][68][69][70] (Table 5).…”

Section: Ultrasoundmentioning

confidence: 99%

“…There still are limitations to the visualization of all areas of the abdomen, and several studies have documented missed bowel injuries [1,12,75]. An additional disadvantage is the need for general anesthesia, and there is evidence that a CO 2 pneumoperitoneum can increase intracranial pressure, compromise intestinal circulation, and may be detrimental to hypovolemic patients [47,64,76,77]. Further research is nessessary, but for the time being, extreme caution and extensive monitoring are mandatory if CO 2 laparoscopy is used for diagnosis and treatment of trauma victims with possible associated head trauma.…”

Section: Diagnostic Laparoscopymentioning

confidence: 99%

Actual Diagnostic Strategies in Blunt Abdominal Trauma

Broos¹,

Gutermann²

2002

Eur J Trauma

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An accurate assessment of patients with potential blunt abdominal trauma should include a safe and reliable method of determining the need for operative intervention because the mortality and morbidity of these injuries are directly dependent on the immediately valid diagnostic work-up. Since peritoneal signs are often subtle, overshadowed by pain from associated injury or masked by head trauma and intoxicants, clinical methods of diagnosis are often unreliable. Since the frequently injured liver and spleen are nowadays more frequently managed nonoperatively, an acute assessment not only of the presence of injury, but also of the nature and extent of the injuries to the intraabdominal organs, raises an increasing demand of both sensitive and specific diagnostic modalities.This article discusses the use of different diagnostic modalities including peritoneal lavage, computed tomography scanning, ultrasound and laparoscopy in the diagnosis and immediate management of blunt abdominal trauma patients, and formulates a trauma protocol for managing these patients.

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A Prospective Study of Emergent Abdominal Sonography after Blunt Trauma

Cited by 125 publications

References 18 publications

Traumatic injuries: imaging of abdominal and pelvic injuries

Traumatic injuries: imaging of abdominal and pelvic injuries

Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation)

Actual Diagnostic Strategies in Blunt Abdominal Trauma

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