CAN ULTRASOUND REPLACE DIAGNOSTIC PERITONEAL-LAVAGE IN THE ASSESSMENTOF BLUNT TRAUMA

Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are th e primary diagnostic modalities in the evaluation of patients with sus pected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is f ast and accurate but associated with complications. Computed tomograph y is also accurate, yet requires that patients be stable and transport able. A prospective study was designed to determine the utility of eme rgency ultrasound (US) studies in the initial assessment of BAT. Two h undred acutely injured patients with suspected BAT were evaluated with US. Patients were eligible for the study if they met trauma criteria and had suspected BAT. Subsequently, without knowledge of the US resul ts, DPL or CT was performed. Ultrasound showed a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in detecting intra-abdomi nal injuries. Six injuries were missed but only one was felt to be sig nificant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.