Usefulness and Limitations of Ultrasonography in the Initial Evaluation of Blunt Abdominal Trauma

Yoshii, Hiroshi; Sato, Mariko; Yamamoto, Shinjiro; Morimoto, Masahiro; Okusawa, Seijiro; Kitano, Mitsuhide; Nagashima, Atsushi; Doi, Motomichi; Takuma, Kiyotsugu; Kato, Kazúo; Aikawa, Naoki

doi:10.1097/00005373-199807000-00009

Cited by 149 publications

(88 citation statements)

References 21 publications

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“…Yoshii et al [10] concluded from their study that ultrasound has poor sensitivity for intestinal injuries and found that the sensitivity, specificity and accuracy were 34.7, 99.9 and 97.3% respectively. Similarly Malhotra et al [8] stated that ultrasound fails in the diagnosis of specific injury causing the fluid and is poor in the detection of hollow viscus injury.…”

Section: Discussionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.

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Section: Discussionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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“…Underlying this paradigm is the understanding that ongoing evaluation through serial examinations or other imaging will be needed to determine whether a patient has any intra-abdominal injury. Most experts would concur that ultrasound has performed best when limited to detecting free intraperitoneal fluid [10,11,19]. Historically, the presence of any intraperitoneal fluid indicated a significant intra-abdominal injury and warranted an immediate exploratory laparotomy.…”

Section: Clinical Implications Of the Focused Assessment With Sonogramentioning

confidence: 99%

Ultrasound in abdominal trauma

Rose

2004

Emergency Medicine Clinics of North America

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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.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Technique varies widely among trauma centers. The examination may consist of a brief survey for fluid alone, or it may include assessment of organ parenchyma.…”

mentioning

confidence: 99%

“…Many authors use free fluid as the only criterion for a positive finding, [1][2][3][4][5][6][7][8][9][10][11][12][13] whereas some describe findings other than fluid as suggestive of traumatic injury as well. [14][15][16][17][18] The inability to show injury without hemoperitoneum has been shown to be a limitation of ultrasonography and may occur in 29% to 34% of patients with injuries caused by BAT. 12,13 The purpose of this study was to determine the benefit of screening for parenchymal abnormalities as well as free fluid during screening abdominal ultrasonography in patients with blunt trauma.…”

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confidence: 99%

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

Brown

Casola

Sirlin

et al. 2001

J of Ultrasound Medicine

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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.

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Usefulness and Limitations of Ultrasonography in the Initial Evaluation of Blunt Abdominal Trauma

Abstract: US is reliable for the detection of injuries and the identification of solid-organ injuries despite its poor sensitivity for intestinal injuries.

Cited by 149 publications

References 21 publications

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Ultrasound in abdominal trauma

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

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