Emergent Abdominal Sonography as a Screening Test in a New Diagnostic Algorithm for Blunt Trauma

Abstract

Although there is an interest in emergent abdominal sonography (EAS), the clinical utilization of EAS in North America is minimal. The purpose of this study was to develop a new diagnostic algorithm for blunt abdominal injury based on a prospective blinded comparison of EAS, diagnostic peritoneal lavage (DPL), and computed tomography (CT). EAS (+ = fluid, - = no fluid) was performed before the DPL or CT, in 400 patients with a mean Injury Severity Score of 26; 293 had a CT and 107 had a DPL. The EASs required 2.6 +/- 1.2 minutes with 82% < or = 3 minutes. The accuracy of EAS for free fluid was 94% with a positive and negative predictive value of 82 and 96%, respectively. Only 1 of 338 patients with EAS- had an acute therapeutic laparotomy. Three patients with EAS- had a delayed laparotomy based on evolving clinical findings. The radiologists interpretation of the EAS video disagreed with the clinician sonographer in only 3% of cases. Based on these results, a diagnostic algorithm was developed using EAS as a screening test with selective use of DPL and CT. Emergent abdominal sonography performed by clinician sonographers is a rapid and accurate test for peritoneal fluid in blunt trauma victims, and the need for laparotomy in patients with a negative EAS is rare. Our study supports the routine use of EAS as a screening test in a diagnostic algorithm for the evaluation of blunt abdominal trauma.

Paramedic Performed Focused Assesment with Sonography in Trauma (FAST) in the Emergency Department

“…[2,[15][16][17][18][19][20][21][22][23][24][25] The results of our study suggest that the accuracy of FAST performed by paramedics working in the ED, and trained in FAST, is comparable to non-radiologist-performed FAST. To our knowledge, this is the first study to assess the accuracy of FAST when performed by paramedics in the ED, trained in the performance and interpretation of FAST.…”

Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

“…In most trauma centers, US is used to monitor low-grade splenic injuries. [15] CT is the gold standard for the diagnosis of spleen injury following a blunt abdominal trauma, especially in patients with stable hemodynamics. [8] CT gives clear information about other peritoneal and retroperitoneal organs as well as the amount of intraabdominal hemorrhage, and in addition, may reveal pseudoaneurysms and arteriovenous fistulas in the spleen.…”

Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centres

“…[8][9][10] Beyond the ED, ultrasonography for trauma assessment has been adopted by military personnel for field use 22 and as a screening test in mass-casualty situations. 23,24 Although bedside ultrasonography has become a modality taught in both adult surgical and emergency medicine residency programs, 15,16 this has not translated into the pediatric training environment.…”

“…EDUS has been shown to be useful in adults as a screening modality for suspected IAI, [8][9][10] with a recent randomized controlled trial showing a 64% reduction in time to operative care compared to CT alone. 11 The applicability of EDUS in children is less well established.…”