THE INDETERMINATE ABDOMINAL SONOGRAM IN MULTISYSTEM BLUNT TRAUMA

Background: North American trauma centers are beginning to note the li mitations of emergent torso sonography. The purpose of this prospectiv e study was to evaluate the frequency, causes, associations, and seque lae of indeterminate (IND) sonograms in blunt trauma, Methods: Among a dult blunt trauma patients assessed with screening torso sonography, c linician sonographers recorded the abdominal sonogram as positive, neg ative, or IND for free fluid. Patients with IND sonograms were further investigated with repeat sonography, computed tomography, or diagnost ic peritoneal lavage. Results: Among 417 patients with blunt trauma (m ean Injury Severity Score = 21) managed with sonography, there were 28 (6;7%) IND and 389 (93.3%) non-IND sonograms, Sonograms were IND beca use of patient factors in 71% (20 of 28) and because of operator facto rs in 29% (8 of 28), None of the 28 patients were managed with repeat sonography alone. All 4 diagnostic peritoneal lavage examinations gave negative results, whereas 8 of 23 computed tomographic scans were abn ormal (6 of 8 patients underwent laparotomy), The mean time required f or diagnostic workup was 117 minutes in the IND group and 48 minutes i n the non-IND group (p < 0.001 in both cases). Conclusion. This prospe ctive study has demonstrated that IND sonograms are not common at our center (6,7%), are usually attributable to patient factors, and are as sociated with greater diagnostic time. Patients with IND sonograms req uire further investigation because they often have injuries requiring laparotomy.