EMERGENT ABDOMINAL SONOGRAPHY AS A SCREENING-TEST IN A NEW DIAGNOSTICALGORITHM FOR BLUNT TRAUMA

Although there is an interest in emergent abdominal sonography (EAS), the clinical utilization of EAS in North America is minimal, The purpo se of this study was to develop a new diagnostic algorithm for blunt a bdominal injury based on a prospective blinded comparison of EAS, diag nostic peritoneal lavage (DPL), and computed tomography (CT), EAS (+ = fluid, - = no fluid) was performed before the DPL or CT, in 400 patie nts with a mean Injury Severity Score of 26; 293 had a CT and 107 had a DPL, The EASs required 2.6 +/- 1.2 minutes with 82% less than or equ al to 3 minutes. The accuracy of EAS for free fluid was 94% with a pos itive and negative predictive value of 82 and 96%, respectively, Only 1 of 338 patients with EAS- had gn acute therapeutic laparotomy. Three patients with EAS- had a delayed laparotomy based on evolving clinica l findings. The radiologists interpretation of the EAS video disagreed with the clinician sonographer in only 3% of cases, Based on these re sults, a diagnostic algorithm was developed using EAS as a screening t est with selective use of DPL and CT, Emergent abdominal sonography pe rformed by clinician sonographers is a rapid and accurate test for per itoneal fluid in blunt trauma victims, and the need for laparotomy in patients with a negative EAS is rare, Our study supports the routine u se of EAS as a screening test in a diagnostic algorithm for the evalua tion of blunt abdominal trauma.