Ultrasound in abdominal trauma

Abstract

Ultrasound in the evaluation of abdominal trauma has evolved over the past 30 years. The use of ultrasound for abdominal trauma was described initially by Kristensen and colleagues [1] in 1971. In 1976, Ascher and colleagues [2] first reported the accuracy of ultrasound in Radiology, with 80% sensitivity for the detection of splenic injury. In a study of 808 patients, Tiling and colleagues [3] in 1990 reported a sensitivity of 89%, a specificity of 100%, and an accuracy of 98%. This same group also was first to comment on the effect of training and experience and reported that surgeons with extensive ultrasound experience could diagnose intra-abdominal fluid with a sensitivity of 96% and an accuracy of 99%. Interest and experience with ultrasound for trauma grew steadily around the world among surgeons and emergency physicians during the early 1990s [4][5][6][7]. During this period, ultrasound technology was improving with regard to price, portability, and resolution, allowing its use during resuscitation. At the same time, in the United States, there was continuing reliance on diagnostic peritoneal lavage (DPL) and CT and much less interest in sonography for abdominal trauma. This all changed when emergency physicians and surgeons in the United States began to publish their experience with ultrasound [4,8,9]. The term Focused Assessment with Sonography for Trauma (FAST) was coined by Rozycki et al [10] in 1996 and has persisted as the accepted acronym for the trauma ultrasound evaluation. The basic four-view examination (perihepatic, perisplenic, pelvic, and pericardial views) has become the foundation of the FAST examination. The rapid, noninvasive, and practical nature of ultrasound for bedside evaluation of critically injured patients has changed the evaluation of blunt abdominal trauma.

Should Echogenic Material in the Urinary Bladder Noticed on FAST Preclude Urinary Catheter Insertion in a Trauma Patient Until Further Evaluation?

“…Ultrasonography has become an indispensable tool in every modern trauma room [1]. While hemodynamic instability calls for immediate surgery, the majority of stable patients require a reliable diagnostic test to discriminate between those who require therapeutic intervention or further study from those who do not.…”

The Role of Ultrasound in Penetrating Trauma

“…In those centers which manage trauma victims and have limitations or difficulties to access certain diagnostic tools and procedures (CT scan, hemodynamic suite, etc. ), sonography should be a routine tool in the emergency department [2,18].…”

“…Although there is growing evidence about new approaches with this diagnostic complementary method (traumatic pneumothorax, prehospital US examination, contrast-enhanced US, 3D approach, etc. ), its use requires a clear educational, training, and credentialing process [2,20].…”

“…The evaluation of abdominal trauma with US has evolved in the last several decades [2]. Originally focused on free fluid assessment among patients with blunt abdominal trauma [3], US indications are now expanding in other trauma fields [4].…”

Diffusion and practice of ultrasound in emergency medicine departments in Italy

“…After the first reports on its efficacy for rapid diagnosis of life-threatening conditions like traumatic hemoperitoneum [1e4] or abdominal aortic aneurysm [5,6], US has been included in numerous diagnostic and therapeutic protocols [7,8] used in emergency medicine. Technological advances have revolutionized care in emergency medicine departments (EMDs) in the United States, allowing US to emerge from the outpatient clinic and arrive at the bedside of the patient and other points of care.…”