Comparative accuracy of diagnostic peritoneal lavage, liver-spleen scintigraphy, and visceral angiography in blunt abdominal trauma.
Diagnostic peritoneal lavage (DPL), liver-spleen scintigraphy (LSS), and visceral angiography (VA) have been cited as useful in the evaluation of patients sustaining blunt abdominal trauma to determine the existence of injuries requiring operative intervention. We have reviewed the clinical courses of 44 patients who sustained blunt abdominal trauma and had various combinations of DPL, LSS, and VA employed in their diagnostic evaluation. The predictive value and efficiency of these tests have been compared in this group of patients. DPL is sensitive and specific for the presence of intraperitoneal blood. LSS is sensitive and specific for parenchymal irregularity in the liver and spleen. VA is sensitive and specific for vascular abnormality, severe hemorrhage, and arteriovenous shunting. None of these tests are completely sensitive and specific for the spectrum of surgically significant injuries produced by blunt abdominal trauma. In this group of patients who had multiple studies because of diagnostic uncertainty, DPL had the highest predictive value and the highest efficiency. LSS results did not by themselves dictate a change in management for any patient. In some patients VA was helpful in determining operative or nonoperative management.
Fifer
T
T
Division of Trauma and Critical Care Surgery, Henry Ford Hospital, Detroit, Michigan.
Obeid
F N
FN
Sorensen
V J
VJ
Horst
H M
HM
Bivins
B A
BA
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging; D014781:Viscera / Q000098:blood supply; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging