Hemoperitoneum score helps determine need for therapeutic laparotomy.
OBJECTIVE
Sonography provides a fast, portable, and noninvasive method for patient assessment. However, the benefit of providing real-time ultrasound (US) imaging and fluid quantification shortly after patient arrival has not been explored. The objective of this study was to prospectively validate a US hemoperitoneum scoring system developed at our institution and determine whether sonography can predict a therapeutic operation.


METHODS
For 12 months, prospective data on all patients undergoing a trauma sonogram were recorded. All sonograms positive for free fluid were given a hemoperitoneum score. The US score was compared with initial systolic blood pressure and base deficit to assess the ability of sonography to predict a therapeutic laparotomy.


RESULTS
Forty of 46 patients (87%) with a US score > or = 3 required a therapeutic laparotomy. Forty-six of 54 patients with a US score < 3 (85%) did not need operative intervention. The sensitivity of sonography was 83% compared with 28% and 49% for systolic blood pressure and base deficit, respectively, in determining the need for therapeutic operation.


CONCLUSIONS
We conclude that the majority of patients with a score > or = 3 will need surgery. The US hemoperitoneum scoring system was a better predictor of a therapeutic laparotomy than initial blood pressure and/or base deficit.
McKenney
K L
KL
Department of Radiology, University of Miami School of Medicine, FL 33136, USA.
McKenney
M G
MG
Cohn
S M
SM
Compton
R
R
Nunez
D B
DB
Dolich
M
M
Namias
N
N
D000007:Abdominal Injuries / Q000150:complications* / Q000601:surgery; D001784:Blood Gas Analysis; D001794:Blood Pressure; D006465:Hemoperitoneum / Q000145:classification* / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007813:Laparotomy; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D018579:Patient Selection; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013599:Systole; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000592:standards; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000601:surgery