The accuracy of diagnostic laparoscopy in trauma patients: a prospective, controlled study.
BACKGROUND
Numerous studies advocate the use of diagnostic laparoscopy (DL) for abdominal trauma, but none have documented its ability to diagnose specific injuries. This study tests the hypothesis that DL can accurately identify all significant intra-abdominal injuries in trauma patients.


METHODS
Of trauma patients requiring laparotomy for presumed injuries, 47 underwent DL followed by laparotomy. Injuries noted at laparoscopy were compared with those found at laparotomy.


RESULTS
Of these, 14 patients had no significant injuries necessitating operative intervention noted at laparoscopy and celiotomy. The remaining 33 patients harbored 93 significant injuries at laparotomy, of which only 57.0% were found by DL. DL possessed poor sensitivity (<50%) for injuries to hollow viscera. Despite DL's poor performance in finding specific injuries, it possessed excellent sensitivity (96.2%), and specificity (100%) for determining the need for therapeutic celiotomy.


CONCLUSIONS
DL offers no clear advantage over diagnostic peritoneal lavage and computed tomography in blunt trauma. Its utility lies in assessment of the need for laparotomy in patients with penetrating wounds. Currently, DL cannot consistently identify all abdominal injuries, disqualifying it as a therapeutic tool in abdominal trauma.
Elliott
D C
DC
Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA.
Rodriguez
A
A
Moncure
M
M
Myers
R A
RA
Shillinglaw
W
W
Davis
F
F
Goldberg
A
A
Mitchell
K
K
McRitchie
D
D
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity