Evaluation of hemoperitoneum using a single- vs multiple-view ultrasonographic examination.
OBJECTIVE
To compare the sensitivities, specificities, and accuracies between a single-view ultrasonography (US) technique and a multiple-view technique for identifying hemoperitoneum in multiple-trauma patients.


METHODS
Data from a prior prospective study of US for trauma diagnosis at a level I trauma center were retrospectively analyzed. A convenience sample of adult patients (> or = 18 years of age) who had presented with major blunt or penetrating torso trauma and had undergone rapid trauma US examinations to detect hemoperitoneum were reviewed. The US interpretations by emergency physicians had been recorded prior to obtaining other diagnostic tests. Five views were evaluated, including the right intercostal oblique view examining Morison's pouch. Evidence of free intraperitoneal fluid by exploratory laparotomy, CT, or diagnostic peritoneal lavage (DPL) was used as the criterion standard.


RESULTS
Of the 245 patients entered into the study, 37 had free intraperitoneal fluid, confirmed by CT, DPL, or exploratory laparotomy. With the multiple-view technique, US was 87% (95% CI = 71%, 96%) sensitive, 100% (95% CI = 97%, 100%) specific, and 98% (95% CI = 95%, 100%) accurate. The single-view technique, evaluating only Morison's pouch, was 51% (95% CI = 34%, 68%) sensitive, 100% (95% CI = 98%, 100%) specific, and 93% (95% CI = 89%, 96%) accurate.


CONCLUSIONS
An initial trauma US examination using a multiple-view technique is more sensitive than that using a single-view technique for detecting hemoperitoneum in trauma patients.
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, USA.
O J
OJ
Ma
M P
MP
Kefer
J R
JR
Mateer
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B
Thoma
D000007:Abdominal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000328:Adult; D004635:Emergency Medicine; D005069:Evaluation Studies as Topic; D006465:Hemoperitoneum / Q000000981:diagnostic imaging*; D006801:Humans; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods