Comparison of ultrasound and physical examination with the gold standard computerized tomography in patients with blunt abdominal trauma

Abstract

BACKGROUND:In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS:In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS:The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION:Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.

Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients

“…Studies have reported a wide range of sensitivity of clinical examination per body region: head (58–93%) [ 40 , 42 ], thoracic (45–60%) [ 40 , 42 ], abdominal (39–59%) [ 40 , 42 , 43 ], pelvic (45–86%) [ 19 , 42 , 44 , 45 ], spinal (60–92%) [ 42 , 46 – 48 ], and extremity injuries (33–91%) [ 42 ]. Similarly, the PPV of clinical examination varied according to body region: head (91%) [ 41 ], thorax (70–90%) [ 11 , 41 ], abdomen (43–70%) [ 41 , 43 ] pelvis (69%) [ 41 ], spine (62%) [ 41 ], and extremity injuries (91%) [ 41 ]. Our study confirmed that the accuracy of initial diagnosis of LLTIs remains moderate to low.…”

“…Accurate initial clinical assessment of trauma patients for LLTIs is a known challenge, especially for internal injuries of torso and major vascular injuries [11,19,[40][41][42][43][44][45][46][47][48]. Studies have reported a wide range of sensitivity of clinical examination per body region: head (58-93%) [40,42], thoracic (45-60%) [40,42], abdominal (39-59%) [40,42,43], pelvic (45-86%) [19,42,44,45], spinal (60-92%) [42,[46][47][48], and extremity injuries (33-91%) [42].…”

“…Accurate initial clinical assessment of trauma patients for LLTIs is a known challenge, especially for internal injuries of torso and major vascular injuries [11,19,[40][41][42][43][44][45][46][47][48]. Studies have reported a wide range of sensitivity of clinical examination per body region: head (58-93%) [40,42], thoracic (45-60%) [40,42], abdominal (39-59%) [40,42,43], pelvic (45-86%) [19,42,44,45], spinal (60-92%) [42,[46][47][48], and extremity injuries (33-91%) [42]. Similarly, the PPV of clinical examination varied according to body region: head (91%) [41], thorax (70-90%) [11,41], abdomen (43-70%) [41,43] pelvis (69%) [41], spine (62%) [41], and extremity injuries (91%) [41].…”