Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage.
OBJECTIVE
Trauma victims with hypotension require a rapid and reliable localization of bleeding and expedient surgical triage. Our hypothesis is that emergent abdominal sonography (EAS) is a rapid and accurate test of the need for urgent laparotomy in blunt trauma victims with hypotension.


METHODS
Among 400 blunt trauma victims entered in a prospective blind study of EAS, a subgroup of 69 (17%) patients had a systolic blood pressure < or = 90 mm Hg during their initial assessment. Although the EAS results [(+) = fluid, (-) = no fluid] were not used in clinical decision making, the potential contribution of EAS to patient care was examined.


RESULTS
The mean Injury Severity Score was 32. Twenty-two (32%) patients were EAS (+), of which 19 required an acute laparotomy. No laparotomies were performed in the 47 EAS (-) patients. The EASs required 19 +/- 5 seconds in the EAS (+) group and 154 +/- 13 seconds in the EAS (-) group. Twenty of the 22 positive EASs had free fluid in Morison's pouch. All 13 patients with an ultrasound score > or = 3 had a laparotomy. The primary etiology of hypotension was blood loss in 42 patients, hemoperitoneum in 18, and retroperitoneal hemorrhage in 12.


CONCLUSIONS
EAS is a rapid and accurate indicator of the need for urgent laparotomy in the hypotensive blunt trauma victim. Further, a negative EAS can hasten the search for other causes of hypotension. Diagnostic peritoneal lavage may become obsolete in centers with EAS capabilities.
Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
L J
LJ
Wherrett
B R
BR
Boulanger
B A
BA
McLellan
F D
FD
Brenneman
S B
SB
Rizoli
J
J
Culhane
P
P
Hamilton
D000007:Abdominal Injuries / Q000150:complications* / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014218:Triage; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging*