title: Operative versus nonoperative management of blunt abdominal trauma: Role of ultrasound-measured intraperitoneal fluid levels.
abstract: This study's objective was to analyze whether the quantity of free intraperitoneal fluid on ultrasonography, alone or in combination with unstable vital signs, is sensitive in determining the need for laparotomy in patients presenting with blunt trauma. Adult patients who presented with blunt abdominal trauma to 2 level I trauma centers were enrolled. Combined intraperitoneal fluid levels (anechoic stripe) of 5 intraperitoneal areas were measured and defined as small (< 1.0 cm), moderate (> 1.0 cm, < 3.0 cm), or large (> 3.0 cm). Unstable vital signs were defined as pulse > 100 bpm or systolic blood pressure < 90 mmHg. Exploratory laparotomy or computed tomography scan confirmed hemoperitoneum. Of 270 patients entered into the study, ultrasound detected free intraperitoneal fluid in 33 patients. Of the 18 patients with a large fluid accumulation, 16 underwent exploratory laparotomy (89% sensitivity), and all 8 patients with unstable vital signs underwent exploratory laparotomy (100% sensitivity). Of the 10 patients with a moderate fluid accumulation, 6 underwent exploratory laparotomy (60% sensitivity), and 4 of the 6 patients with unstable vital signs underwent exploratory laparotomy (67% sensitivity). A large intraperitoneal fluid accumulation on ultrasonography in combination with unstable vital signs, is sensitive for determining the need for exploratory laparotomy in patients presenting with blunt trauma.
authors.affiliation: Department of Emergency Medicine, Truman Medical Center, Kansas City, MO 64108, USA. john.ma@tmcmed.org
authors.forename: O J
authors.initials: OJ
authors.lastname: Ma
authors.forename: M P
authors.initials: MP
authors.lastname: Kefer
authors.forename: K F
authors.initials: KF
authors.lastname: Stevison
authors.forename: J R
authors.initials: JR
authors.lastname: Mateer
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D006439:Hemodynamics; D006465:Hemoperitoneum / Q000000981:diagnostic imaging*; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D014218:Triage / Q000191:economics / Q000379:methods*; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery