Diagnostic peritoneal lavage: is an isolated WBC count greater than or equal to 500/mm3 predictive of intra-abdominal injury requiring celiotomy in blunt trauma patients?
A 5-year retrospective review of 3,503 diagnostic peritoneal lavage (DPL) patients was conducted, identifying 48 (13%) blunt trauma patients who had a DPL WBC count greater than or equal to 500/mm3. The mean DPL WBC count was 1,646 +/- 2,275. Twenty (42%) of these patients were observed and discharged without subsequent operation or morbidity. Laparotomy was performed on 28 (58%) patients; 17 (61%) had a negative lap, 11 (39%) had intra-abdominal injuries requiring surgical repair or drainage (54% solid organ, 27% hollow viscus, 18% diaphragmatic). There were no significant differences between the three subgroups with regards to age, injury severity, time interval between injury and DPL, or mean DPL WBC count (p greater than 0.05). The negative-lap and no-lap groups had a significantly larger number of females; one presented with PID. The positive predictive value (PPV) of an isolated lavage WBC count of greater than or equal to 500/mm3 for intra-abdominal injury was 23% (11/48). The PPVs for DPLs performed less than and greater than or equal to 3 hours or those recalculated using WBC values higher than 500/mm3 were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)
Soyka
J M
JM
Department of Surgery, Cook County Hospital, Chicago, IL 60612.
Martin
M
M
Sloan
E P
EP
Himmelman
R G
RG
Batesky
D
D
Barrett
J A
JA
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005189:False Positive Reactions; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis; D006801:Humans; D007813:Laparotomy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*