Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma

OBJECTIVE. The purpose of this study was to evaluate the efficacy of sonogr aphy in our algorithm when differentiating patients with blunt abdominal tr auma who need immediate surgery from patients who would benefit from furthe r diagnostic workup or who need no treatment. SUBJECTS AND METHODS. We performed abdominal sonography as the primary scre ening tool in 1671 consecutive patients in our prospective study. Radiologi sts performed sonography in the trauma room within minutes of the arrival o f each patient. Hemodynamic instability in conjunction with positive sonogr aphic findings led to emergency laparotomy, Otherwise, positive sonographic findings warranted additional diagnostic tests. Observing free fluid or or gan injury caused us to categorize sonographic findings as positive. RESULTS. Sonography correctly identified all patients requiring emergency l aparotomy. No inconclusive laparotomies were performed in this group. The s ensitivity of sonography for revealing intraabdominal injury was 88%, the s pecificity was 100%, and the accuracy was 99%. In 132 patients (8%), abdomi nal CT was performed. CT revealed relevant posttraumatic abnormalities in 6 1% of all patients. Four hundred seventy patients with negative sonographic findings were discharged approximately 12 hr after admission; two of these patients (0.4%) were mistakenly discharged. Trauma scores did not influenc e the efficacy of sonography. CONCLUSION. Our algorithm that uses sonography as the primary diagnostic to ol provides accurate, fast, cost-effective, and noninvasive initial managem ent of patients with blunt abdominal trauma. Our test characteristics were excellent indicators of the need for emergency laparotomy. Sonography also achieves high values in revealing relevant injury. Our algorithm produced m edically satisfactory and economically prudent management of patients with blunt abdominal trauma.