Abdominal Paracentesis and Peritoneal Lavage in Blunt Abdominal Trauma

Olsen, William R.; Hildreth, Douglas H.

doi:10.1097/00005373-197110000-00002

Cited by 94 publications

(19 citation statements)

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“…Speed and efficiency are important factors in the performing such tests [3] . It is reported that peritoneal lavage cell count may also be useful in early detection of hollow viscus injury [11,12] . Although DPL is sensitive in identifying haemoperitoneum and associated hollow viscus injury, it has been criticised for its higher rate of non-therapeutic laparotomy (NTL) and inconvenience in practice [12] .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of colonic injuries following blunt trauma

Zheng

Chen²,

Tao³

et al. 2007

WJG

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AIM:To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. METHODS:A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. RESULTS:Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injuryrelated abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). CONCLUSION:Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and management of colonic injuries following blunt trauma

Zheng

Chen²,

Tao³

et al. 2007

WJG

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“…Prevalence of intra-abdominal injury varies widely, ranging from 7.7% to 65%. Physical examination is approximately 55% 36,37 to 65% 4,38,39 accurate. Decision analysis is a method that can identify the best course of action in complex situations.…”

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confidence: 99%

Diagnostic Evaluation of Patients with Blunt Abdominal Trauma: A Decision Analysis

Brown

Dunn

Wilson

2000

Academic Emergency Medicine

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Abstract. Objectives: Using decision analysis, to compare the expected utility (EU) of diagnostic peritoneal lavage (DPL), computed tomography (CT), and ultrasonography (US) to determine the optimal modality for the evaluation of blunt abdominal trauma (BAT) in hemodynamically stable adults. Methods: Data points for the decision analysis were obtained from three sources: 1) prevalence of BAT and the sensitivity and specificity of each diagnostic modality were determined through a criteria-based review of the literature; 2) rate of BAT necessitating immediate intervention, perioperative complication rate, and operative mortality rate were calculated using data from the authors' institution's trauma registry; and 3) outcome utilities were determined by telephone survey of adults in a random sample of households in the region. The decision tree was constructed and evaluated in standard fashion. For each diagnostic modality, the authors calculated the EU using the minimum, mean, and maximum sensitivity and specificity across a range of prevalence. Mean outcome utilities were used for each branch of the tree when calculating the EU. Results: The EU of CT was consistently lower than the EUs of DPL and US at all levels of prevalence. However, the rank order of the EUs of US and DPL varied with the prevalence of BAT. When the prevalence was <30%, the EU of US was higher than that for DPL. When the prevalence was 30-40%, the EUs were similar. When the prevalence was >40%, the EU of US was less than that of DPL. Conclusions: Among institutions operating under constraints similar to those used in this model, the optimal diagnostic modality for the evaluation of BAT can be determined based on the sensitivity and specificity of the modality at their institution and the prevalence of BAT in their patient population.

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“…It is well established that physical signs are untrustworthy in the assessment of patients with significant abdominal injuries33 often due to other distracting injuries,13 or altered levels of consciousness 34. This makes the PH management of this patient group extremely difficult.…”

Section: Discussionmentioning

confidence: 99%

Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

Brooke

Walton

Scutt

2010

Emergency Medicine Journal

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The theoretical concept that paramedic-initiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes.

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Abdominal Paracentesis and Peritoneal Lavage in Blunt Abdominal Trauma

Cited by 94 publications

References 0 publications

Diagnosis and management of colonic injuries following blunt trauma

Diagnosis and management of colonic injuries following blunt trauma

Diagnostic Evaluation of Patients with Blunt Abdominal Trauma: A Decision Analysis

Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

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