ULTRASONOGRAPHY IN THE MANAGEMENT OF BLUNT ABDOMINAL AND THORACIC TRAUMA

Objective: To assess the sensitivity, specificity, and predictive valu e of ultrasonography in patients with blunt abdominal or thoracic trau ma in regard to the indication for immediate operation, delayed abdomi nal exploration, or conservative treatment. Design: A retrospective st udy was conducted after consecutive sampling of 1151 patients in a non randomized control trial. Setting: The study was conducted at the Univ ersity Hospital of Innsbruck (Austria), which serves as a general comm unity hospital and a major primary care and referral center. Patients: All patients with blunt abdominal or thoracic trauma with or without polytraumatization were eligible for the study; a total of 1151 patien ts were observed from 1980 to 1990. According to the ultrasonographic findings, patients were divided into three groups: immediate operation , primary conservative treatment, and conservative treatment (normal u ltrasonographic findings). Ultrasonography was repeated when the clini cal findings or laboratory test results showed the development of intr a-abdominal hemorrhage or signs of organ laceration. Intervention: Ult rasonography in the emergency department or intensive care unit. Main Outcome Measures: Conservative or operative treatment based on ultraso nographic and clinical findings. Results: Ultrasonography showed a sen sitivity of 99%, a specificity of 98%, a positive predictive value of 0.97, and a negative predictive value of 0.99 in regard to the indicat ion for surgery in cases of blunt abdominal or thoracic trauma. Ultras onography is not reliable in patients with intestinal perforation and large retroperitoneal hematomas. Conclusion: Ultrasonography saves tim e and money, can be performed in the emergency department, shows high sensitivity and specificity, and is the method of first choice in the evaluation of blunt trauma.