title: What does ultrasonography miss in blunt trauma patients with a low Glasgow Coma Score (GCS)?
abstract: BACKGROUND
  The role of ultrasound (US) as a screening tool for the evaluation of blunt abdominal trauma is still controversial. Determining the types of missed injuries and the accuracy of US in patients with a low GCS will improve the evaluation of these blunt trauma patients.
  
  
  METHODS
  Prospectively collected data from the trauma registry of a Level I trauma center was reviewed.
  
  
  RESULTS
  7,952 patients were included in the study. US examination had an accuracy of 89%, sensitivity of 77%, specificity of 97%, positive predictive value (PPV) of 78%, and negative predictive value (NPV) of 98%. GCS correlated with ISS and base deficit levels. US examination had a significantly lower accuracy in patients with a low GCS and in women.
  
  
  CONCLUSIONS
  The sensitivity and specificity of US examination is similar in those with normal and low GCS. Therefore ultrasonographic examination may be considered a good screening tool for the evaluation of patients with blunt abdominal trauma, but its accuracy is diminished in patients with a low GCS. Further imaging may be warranted in these patients.
authors.affiliation: Dewitt Daughtry Family Department of Surgery, Division of Trauma, University of Miami School of Medicine, Miami, Florida 33101, USA.
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Mark G
authors.initials: MG
authors.lastname: McKenney
authors.forename: Stephen
authors.initials: S
authors.lastname: Cohn
authors.forename: Nicolas Alvarez
authors.initials: NA
authors.lastname: Renaud
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Mauricio
authors.initials: M
authors.lastname: Lynn
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*