Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma.

Abstract

Objective. To determine the benefit of screening ultrasonography for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma. Methods. A total of 2693 patients with blunt trauma who were triaged to a level 1 trauma center underwent screening abdominal ultrasonography in the resuscitation suite. Examinations were performed by experienced sonographers and included a screen for free intraperitoneal fluid and evaluation of the abdominal organ parenchyma and heart for traumatic injury. Screening ultrasonographic findings were reviewed and compared with findings from autopsy, laparotomy, diagnostic peritoneal lavage, computed tomography, repeated ultrasonography, cystography, and clinical outcome. Imaging studies of all patients with confirmed or suspected injuries were reviewed to identify those in whom parenchymal findings aided diagnosis. Results. One hundred seventy-two patients were found to have evidence of abdominal injury due to blunt trauma on the basis of clinical data, imaging, laparotomy, or autopsy. Forty-four of these patients had no sonographic evidence of hemoperitoneum at the time of initial ultrasonography. Screening ultrasonographic findings were positive for injury in 19 of 44 patients on the basis of parenchymal findings or small retroperitoneal collections of fluid thought to be indicative of trauma. In the remaining 25 patients, screening ultrasonography showed no abnormalities, and injuries were detected by repeated ultrasonography, subsequent computed tomography, or diagnostic peritoneal lavage performed for suspected occult injury on the basis of clinical parameters. In addition, 47 of 126 injured patients with sonographically detected free fluid had parenchymal findings that helped localize injury. Sixteen of those patients were taken to the operating room on the basis of clinical and sonographic findings without undergoing computed tomography. Conclusions. The inability to show injuries with no hemoperitoneum or with delayed hemoperitoneum has been shown to be a limitation of ultrasonography in patients with blunt trauma. In our series, 26% of all patients with documented injuries had no free fluid visible on screening ultrasonography. Attention to findings other than free fluid allowed detection in 43% of injured patients without sonographic evidence of hemoperitoneum.

Ultrasound in abdominal trauma

“…Isolated solid-organ injuries without hemoperitoneum are much more difficult to detect. Brown et al [50] reported on 2693 blunt trauma patients and found that 26% of the patients with injuries had no hemoperitoneum. They also found that they could detect subtle findings of injury in 46% of those patients, including parenchymal injuries and retroperitoneal fluid.…”

Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience

“…Emergency US performed to detect haemoperitoneum is termed focused assessment with sonography for trauma (FAST) and has 81%-94% sensitivity, 88%-100% specificity and 86%-98% diagnostic accuracy [11][12][13][14][15][16]. Its major limitation is its poor sensitivity (41%-44%) in the direct depiction of solid abdominal organ lesions [17][18][19]. Whereas it is generally recognised that US has a key role in unstable patients [20], its use in stable patients remains controversial owing to its inability to exclude abdominal organ lesions, even in the presence of negative findings, with the result that patients need to undergo contrast-enhanced computed tomography (CT).…”

Contrast–enhanced ultrasound in trauma

“…Studies have been performed to evaluate the reliability of ultrasound for directly visualizing injuries within the abdomen. One included 2693 patients with blunt abdominal trauma: the sensitivity of ultrasound to abdominal injury was only 43% compared to CT or other standards such as laparotomy and autopsy [5]. This also applies to children [6]; in this study the advantages of ultrasound are mentioned; it is quickly performed and less frightening to an injured child than a CT examination.…”