ULTRASOUND IN BLUNT ABDOMINAL AND THORACIC TRAUMA

Between July 1989 and June 1991, 312 patients with blunt thoracic or a bdominal injuries were examined prospectively. Sonographic examination was performed by surgeons in the emergency room using a mobile ultras ound unit. In 113 (36.2%) cases pathologic findings were demonstrated sonographically. These included 47 cases of hemothorax, 11 pericardial effusions, 52 cases of intra-abdominal fluid, 24 lesions of intra-abd ominal organs, and 10 cases of retroperitoneal hematoma. Physical exam ination findings were positive in 96 (30.8%), negative in 63 (20.2%), and equivocal in 153 (49.0%). Two hundred thirty-nine patients had bet ween one and eight injuries in addition to the blunt abdominal or thor acic trauma. These patients had an average Injury Severity Score (ISS) of 19.9 (range, 1 to 75). The 73 patients with isolated blunt trauma of the thorax or abdomen had an ISS of 4.9 (range, 0-25). None of the 66 patients (21.2%) with positive clinical findings and negative sonog raphic examination results had to be operated on later in the course o f treatment, while 5 (36%) of 14 patients (4.5%) with negative physica l examination findings and positive sonographic findings had to underg o surgery. The sensitivity for the demonstration of intra-abdominal fl uid and organ lesions was 98.1% and 41.4%, respectively. The overall s ensitivity and specificity of the ultrasonic examination were 90.0% an d 99.5%, respectively.