A Prospective Study of Surgeon-Performed Ultrasound as the Primary Adjuvant Modality for Injured Patient Assessment

Abstract

Ultrasound diagnostic imaging, having been used in Germany in the trauma setting for more than 15 years, has unique qualities that give it distinct advantages over other tests (DPL, CT), and is gradually gaining acceptance by surgeons in the United States. In this prospective study, experienced surgeon sonographers successfully used ultrasound as the primary adjuvant modality to detect hemoperitoneum and pericardial effusion in injured patients. The ultrasound evaluations of 371 patients demonstrated that in 65 patients with significant injuries, ultrasound detected 53, that is, had an 81.5% sensitivity and 99.7% specificity. They conclude that ultrasound should be the primary adjuvant instrument for the evaluation of injured patients because it is rapid, accurate, and is potentially cost-effective.

Ultrasound in abdominal trauma

“…Underlying this paradigm is the understanding that ongoing evaluation through serial examinations or other imaging will be needed to determine whether a patient has any intra-abdominal injury. Most experts would concur that ultrasound has performed best when limited to detecting free intraperitoneal fluid [10,11,19]. Historically, the presence of any intraperitoneal fluid indicated a significant intra-abdominal injury and warranted an immediate exploratory laparotomy.…”

“…This all changed when emergency physicians and surgeons in the United States began to publish their experience with ultrasound [4,8,9]. The term Focused Assessment with Sonography for Trauma (FAST) was coined by Rozycki et al [10] in 1996 and has persisted as the accepted acronym for the trauma ultrasound evaluation. The basic four-view examination (perihepatic, perisplenic, pelvic, and pericardial views) has become the foundation of the FAST examination.…”

Abordagem Geral Trauma Abdominal

“…A maioria dos estudos de ultrassonografia abdominal em pacientes politraumatizados recomenda a sua utilização como exame diagnóstico inicial, teste de "screening" (Focused Assessment for Sonography in Trauma -FAST) ou estudo adjuvante complementar à tomografia computadorizada ou ao lavado peritoneal diagnóstico, devendo ser realizado na própria sala de admissão por médico capacitado 18,19 . O objetivo do exame é a detecção e quantificação do hemoperitônio para identificar os pacientes com lesão e não o diagnóstico do órgão lesado.…”

“…O objetivo do exame é a detecção e quantificação do hemoperitônio para identificar os pacientes com lesão e não o diagnóstico do órgão lesado. Sua sensibilidade está entre 80 e 99% na detecção de hemorragia intraabdominal 18,19 . Figura 3.…”

“…Após o exame inicial, o mesmo pode ser repetido para detectar hemoperitônio progressivo 18,19 . A ultrassonografia tem substituído o lavado peritoneal diagnóstico em função das suas vantagens 18 : é de fácil utilização, pode ser portátil, é de rápida execução, pode ser repetido, e não tem risco dos efeitos da radiação 19 …”