SONOGRAPHIC EXAMINATION OF ABDOMINAL-TRAUMA BY SENIOR SURGICAL RESIDENTS

The focused ultrasound examination is assuming an important role in th e evaluation of abdominal trauma. We evaluated the ability of senior s urgical residents to independently use this technique. We also evaluat ed the efficacy of a single sonographic examination instead of serial examinations. Senior surgical residents underwent sonography instructi on by two attending surgeons certified in the technique. Once proficie ncy was attained, a single sonographic examination was performed on pa tients with abdominal trauma triaged to a Level I trauma center. Resid ents obtained additional diagnostic studies deemed appropriate. Ultras ound results were compared with other diagnostic studies and clinical course. Sonography was performed on 518 patients between January 10, 1 995 and June 30, 1996. Mechanism of injury was blunt in 92 per cent of patients and penetrating in 8 per cent. There were 22 true positives, 12 false positives, 8 false negatives, and 476 true negatives. Five o f the eight false negatives were secondary to limited hollow viscus in juries with minimal associated intraperitoneal fluid. Sensitivity, spe cificity, accuracy, positive predictive value, and negative predictive value were 73.3, 97.5, 96.1, 64.7, and 98.3 per cent, respectively. T he use of computed tomography and diagnostic peritoneal lavage decreas ed from 25 to 18 per cent and 3.2 to 0.2 per cent, respectively, as di agnostic tools. We conclude that surgical residents can competently pe rform trauma ultrasound. A single sonographic examination is effective and reliable. Sonography has essentially replaced diagnostic peritone al lavage in our institution.