title: Abdominal ultrasonography and chest radiography are of limited value in the emergency room diagnostic work-up of severe trauma patients with hypotension on the scene of accident.
abstract: OBJECTIVE
  To evaluate the reliability of chest radiograph (CR) and abdominal ultrasonography (US) performed in the Emergency Room (ER) in identifying life-threatening thoracic or abdominal lesions in a group of severely injured patients, who developed arterial hypotension immediately after a trauma.
  
  
  METHODS
  The results of all abdominal US and CX performed in the ER in severe blunt trauma patients, with on-the-scene systolic blood pressure 90 mmHg, from November 2000 to November 2002, were analysed. When these initial investigations failed to identify a possible cause of hypotension, a computed tomography (CT) of the chest and abdomen was obtained.
  
  
  RESULTS
  Overall, 54 patients were studied; twenty-two patients (40.8%) were hypotensive both on accident scene and on the arrival at the ER and 32 (59.2%) were hypotensive on accident scene, but not in the ER. Forty-five patients had an US in the ER, in 3 patients it was inconclusive, whereas 2 other patients died before the confirmatory investigations could be performed. Among the remaining 40 patients, 11 had a hemoperitoneum (HP) hat was diagnosed by US in 7 cases and missed in 4. Twenty-nine patients had no HP and their US was negative in 24 cases and positive in 5; the US had a sensibility of 63.6% and a specificity of 82.8% The CR was obtained in the ER in 39 patients and it was able to identify 6 pneumothoraces (PNX) out of 20 and 2 hemothoraces (HT) out of 17; the sensitivity for PNX and HT was 30.0% and 11.8%, respectively. One patient with an aortic dissection had a normal CX.
  
  
  CONCLUSIONS
  Both CX and US are not reliable to identify possible PNX, HT and HP in hypotensive trauma patients and can delay the treatment of life-threatening conditions. In these patients, a CT of the torso is warranted.
authors.affiliation: Servizio di Elisoccorso della Regione Friuli Venezia-Giulia, Ospedale S. Maria della Misericordia, Udine, 1-33100 Udine UD. danielemassarutti@libero.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Massarutti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Berlot
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Saltarini
authors.forename: Giulio
authors.initials: G
authors.lastname: Trillò
authors.forename: Loris
authors.initials: L
authors.lastname: D'Orlando
authors.forename: Francesco
authors.initials: F
authors.lastname: Pessina
authors.forename: Aldo
authors.initials: A
authors.lastname: Modesto
authors.forename: Stefano
authors.initials: S
authors.lastname: Meduri
authors.forename: Tharita
authors.initials: T
authors.lastname: Da Ronch
authors.forename: Elio
authors.initials: E
authors.lastname: Carchietti
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D015599:Trauma Severity Indices; D014463:Ultrasonography