Diagnostic peritoneal lavage remains a valuable adjunct to modern imaging techniques.
BACKGROUND
Continuing improvements in computerized tomography scan technology and widespread acceptance of focused abdominal sonography for trauma (FAST) have prompted the suggestion that diagnostic peritoneal lavage (DPL) is obsolete. This sentiment, coupled with decreasing resident familiarity with DPL, has led to a poor understanding of the modern indications for DPL and no clear guidelines. We hypothesized that, while its indications may have changed, DPL remains essential in the rapid, effective triage of the trauma patient.


METHODS
We queried our Level I trauma center's trauma registry from January 1996 through August 2006 for patients who underwent a DPL as part of their initial evaluation. Specific variables investigated were indications for or results of DPL, performance of a laparotomy in the first 24 hours, and operative findings.


RESULTS
Six hundred twenty-seven patients underwent DPL (145 positive, 482 negative). Although the accuracy of DPL for predicting therapeutic laparotomy for all patients was only 77%, in the subset of hemodynamically unstable patients (of which only 46% had a positive FAST), it was 100%. Conversely, only 7% of all patients with negative DPL subsequently had a therapeutic laparotomy, with only 5% in the subset of stab wounds.


CONCLUSIONS
DPL continues to be a vital tool in the evaluation of the trauma patient. A positive test in the hemodynamically unstable patient with potential multisystem trauma allows for expeditious intervention. A negative test in abdominal stab wounds supports observation and early subsequent discharge. Our current guidelines continue to emphasize the complimentary roles of DPL, FAST, and computerized tomography scan in the trauma bay.
Cha
John Y
JY
Department of Surgery, University of South Florida College, Tampa, Florida, USA.
Kashuk
Jeffry L
JL
Sarin
Eric L
EL
Cothren
C Clay
CC
Johnson
Jeffrey L
JL
Biffl
Walter L
WL
Moore
Ernest E
EE
D000007:Abdominal Injuries / Q000175:diagnosis*; D003120:Colorado; D006801:Humans; D010533:Peritoneal Lavage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis; D014951:Wounds, Stab / Q000175:diagnosis*