DIAGNOSTIC-ACCURACY OF PERITONEAL-LAVAGE IN PATIENTS WITH PELVIC FRACTURES

Objective: To determine the accuracy of diagnostic peritoneal lavage ( DPL) for the evaluation of intraabdominal injury in patients with a pe lvic fracture as a result of blunt trauma. Design: Retrospective cohor t analysis. Setting: Level 1 trauma center in metropolitan Seattle, Wa sh. Patients: Four hundred ninety-seven consecutive patients admitted with pelvic fractures following blunt trauma during a 60-month period. Outcome Measures: Positive results of DPL, defined by one of the foll owing: an immediate aspiration of more than 10 mt of gross blood; a re d blood cell count of more than 0.0001 X 10(12)/L; a white blood cell count greater than 0.0005 X 10(9)/L; an elevated amylase, bilirubin, o r creatinine level; or organic particles or bacteria in the effluent r eturned after installation of 1 L of crystalloid fluid lavaged in the peritoneal cavity. Results: Two hundred eighty-six patients underwent DPL. For 80 patients (28.0%), results of DPL were positive and for 194 patients (67.8%) the results of DPL were negative. For two patients ( 0.7%), results of DPL were false positive for a sensitivity of 94%. Fo r another two patients (0.7%), the results of DPL were false negative for a specificity of 99%. As a diagnostic modality, DPL has a positive predictive value of 98% and a negative predictive value of 97%. Concl usions: Diagnostic peritoneal lavage is a reliable method for the eval uation of intra-abdominal injury and should remain a standard componen t in the evaluation of patients following blunt injury with or without pelvic fractures.