TY - JOUR
T1 - Operative versus nonoperative management of blunt abdominal trauma
T2 - Role of ultrasound-measured intraperitoneal fluid levels
AU - Ma, O. John
AU - Kefer, Michael P.
AU - Stevison, Kathleen F.
AU - Mateer, James R.
PY - 2001
Y1 - 2001
N2 - This study's objective was to analyze whether the quantity of free intraperitoneal fluid on ultrasonography, alone or in combination with unstable vital signs, is sensitive in determining the need for laparotomy in patients presenting with blunt trauma. Adult patients who presented with blunt abdominal trauma to 2 level I trauma centers were enrolled. Combined intraperitoneal fluid levels (anechoic stripe) of 5 intraperitoneal areas were measured and defined as small (< 1.0 cm), moderate (> 1.0 cm, < 3.0 cm), or large (> 3.0 cm). Unstable vital signs were defined as pulse > 100 bpm or systolic blood pressure < 90 mmHg. Exploratory laparotomy or computed tomography scan confirmed hemoperitoneum. Of 270 patients entered into the study, ultrasound detected free intraperitoneal fluid in 33 patients. Of the 18 patients with a large fluid accumulation, 16 underwent exploratory laparotomy (89% sensitivity), and all 8 patients with unstable vital signs underwent exploratory laparotomy (100% sensitivity). Of the 10 patients with a moderate fluid accumulation, 6 underwent exploratory laparotomy (60% sensitivity), and 4 of the 6 patients with unstable vital signs underwent exploratory laparotomy (67% sensitivity). A large intraperitoneal fluid accumulation on ultrasonography in combination with unstable vital signs, is sensitive for determining the need for exploratory laparotomy in patients presenting with blunt trauma.
AB - This study's objective was to analyze whether the quantity of free intraperitoneal fluid on ultrasonography, alone or in combination with unstable vital signs, is sensitive in determining the need for laparotomy in patients presenting with blunt trauma. Adult patients who presented with blunt abdominal trauma to 2 level I trauma centers were enrolled. Combined intraperitoneal fluid levels (anechoic stripe) of 5 intraperitoneal areas were measured and defined as small (< 1.0 cm), moderate (> 1.0 cm, < 3.0 cm), or large (> 3.0 cm). Unstable vital signs were defined as pulse > 100 bpm or systolic blood pressure < 90 mmHg. Exploratory laparotomy or computed tomography scan confirmed hemoperitoneum. Of 270 patients entered into the study, ultrasound detected free intraperitoneal fluid in 33 patients. Of the 18 patients with a large fluid accumulation, 16 underwent exploratory laparotomy (89% sensitivity), and all 8 patients with unstable vital signs underwent exploratory laparotomy (100% sensitivity). Of the 10 patients with a moderate fluid accumulation, 6 underwent exploratory laparotomy (60% sensitivity), and 4 of the 6 patients with unstable vital signs underwent exploratory laparotomy (67% sensitivity). A large intraperitoneal fluid accumulation on ultrasonography in combination with unstable vital signs, is sensitive for determining the need for exploratory laparotomy in patients presenting with blunt trauma.
KW - Hemoperitoneum
KW - Trauma
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=0034937330&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034937330&partnerID=8YFLogxK
U2 - 10.1053/ajem.2001.24476
DO - 10.1053/ajem.2001.24476
M3 - Article
C2 - 11447513
AN - SCOPUS:0034937330
SN - 0735-6757
VL - 19
SP - 284
EP - 286
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 4
ER -