USE OF ULTRASONOGRAPHY IN THE PATIENT WITH ACUTE ABDOMINAL-TRAUMA

The purpose of this study was to assess the use of ultrasonography in patients with acute abdominal trauma. Five hundred prospective patient s, who came to the Emergency Department with acute trauma, were evalua ted with ultrasonography and included in this study. The ultrasonograp hic examination focused on detection of free fluid but included evalua tion of parenchymal organs for injury. The physical examination was no t used in the statistical analysis of the sonographic findings. In com paring ultrasonography to computed tomography, diagnostic peritoneal l avage, or operative findings, we obtained 24 true positive, 79 true ne gative, four false positive, and 14 false negative results. Sensitivit y of ultrasonography in detecting free fluid in comparison to computed tomography, diagnostic peritoneal lavage, and surgery was 63%, specif icity was 95%, accuracy was 85%, positive predictive value was 86%, an d negative predictive value was 85%. The most common reason for false negative sonographic results was identification of free fluid in the p elvis on computed tomograms but not on ultrasonograms owing to lack of a full bladder. In none of these instances were the sonographic false negative results of clinical significance. Ultrasonography allowed de tection of solid organ injury of the liver in one of seven cases, of t he kidney in one of four cases, and in the bowel in zero of three case s. In the three instances of bowel injury, free fluid was noted on ult rasonograms. Ultrasonography fared better in cases of splenic lacerati on, permitting detection in nine of 14 cases. The emergent ultrasonogr am may be used to detect free fluid in the abdomen of the acutely trau matized patient. However, sonography is limited in detecting free flui d in the pelvis using the present technique and does not allow visuali zation of organ injury. Limitations of this examination should be reco gnized for appropriate triage of the acutely traumatized patient.