ULTRASONOGRAPHY IN THE INITIAL EVALUATION AND FOLLOW-UP OF BLUNT ABDOMINAL INJURY

Background. Ultrasonography has been routinely performed in the assess ment of blunt abdominal injury at our department of surgery since 1980 . To establish its reliability, a retrospective study was carried out on 818 consecutive patients in the years 1980 to 1990. Methods. Seven hundred twenty six patients underwent real-time ultrasonographic exami nation of the abdomen. Indication for ultrasonography included all cas es evaluated for blunt abdominal trauma. Ninety two patients before 19 85 were excluded. Results. Two hundred seventy (3 7.2%) patients under went laparotomy, 252 patients (34.7%) because of ultrasonographic diag nosis. Celiotomy was nontherapeutic in 28 patients; 26 of these patien ts had positive findings from ultrasonography (false positive, 3.6%). Eighteen patients with negative findings from ultrasonography also und erwent laparotomy, which was nontherapeutic in two patients (false neg ative, 2.2%). Four hundred fifty six patients (62.8%) were managed wit hout operation, relying on initial and follow-up ultrasonography, whic h was negative in 386 (53.2%) and positive in 70 patients (9.6%). The accuracy of ultrasonography was 94.2%, with 91.9% sensitivity, 96.0% s pecificity, and .94.9% predictive value. The rate of delayed recogniti on of documented visceral injury was 5.1%, but no false-negative findi ngs from ultrasonography were noted among these patients. Conclusions. Ultrasonography has proved to be a thoroughly reliable, cost efficien t, and noninvasive modality in primary evaluation and follow-up of blu nt abdominal trauma.