EVALUATION OF HEMOPERITONEUM USING A SINGLE-VIEW VS MULTIPLE-VIEW ULTRASONOGRAPHIC EXAMINATION

Objective: To compare the sensitivities, specificities, and accuracies between a single-view ultrasonography (US) technique and a multiple-v iew technique for identifying hemoperitoneum in multiple-trauma patien ts. Methods: Data from a prior prospective study of US for trauma diag nosis at a level I trauma center were retrospectively analyzed. A conv enience sample of adult patients (greater than or equal to 18 years of age) who had presented with major blunt or penetrating torso trauma a nd had undergone rapid trauma US examinations to detect hemoperitoneum were reviewed. The US interpretations by emergency physicians had bee n recorded prior to obtaining other diagnostic tests. Five views were evaluated, including the right intercostal oblique view examining Mori son's pouch. Evidence of free intraperitoneal fluid by exploratory lap arotomy, CT, or diagnostic peritoneal lavage (DPL) was used as the cri terion standard. Results: Of the 245 patients entered into the study, 37 had free intraperitoneal fluid, confirmed by CT, DPL, or explorator y laparotomy. With the multiple-view technique, US was 87% (95% CI = 7 1%, 96%) sensitive, 100% (95% CI = 97%, 100%) specific, and 98% (95% C I = 95%, 100%) accurate. The single-view technique, evaluating only Mo rison's pouch, was 51% (95% CI = 34%, 68%) sensitive, 100% (95% CI = 9 8%, 100%) specific, and 93% (95% CI = 89%, 96%) accurate. Conclusions: An initial trauma US examination using a multiple-view technique is m ore sensitive than that using a single-view technique for detecting he moperitoneum in trauma patients.