Performance of abdominal ultrasonography in blunt trauma patients with out-of-hospital or emergency department hypotension☆
Received 29 May 2003; received in revised form 10 September 2003; accepted 12 September 2003.
Abstract
Study objectives
We determine the test performance of abdominal ultrasonography for detecting hemoperitoneum in blunt trauma patients with out-of-hospital or emergency department (ED) hypotension.
Methods
We reviewed the medical records of all blunt trauma patients hospitalized at a Level I trauma center. Patients were included if they were older than 6 years and had out-of-hospital or ED hypotension (systolic blood pressure ≤90 mm Hg) and underwent ED ultrasonography. The initial interpretation of the abdominal ultrasonography was recorded, including the presence or absence of intraperitoneal fluid and the specific location of such fluid. Presence or absence of intra-abdominal injury was determined by abdominal computed tomography scan, laparotomy, or clinical follow-up.
Results
Four hundred forty-seven patients with a mean age of 36.0±17.5 years were enrolled. One hundred forty-eight (33%) patients had intra-abdominal injuries, and 116 (78%) of these patients had hemoperitoneum. Abdominal ultrasonography had the following test performance for detecting patients with intra-abdominal injury and hemoperitoneum: sensitivity 92/116 (79%; 95% confidence interval [CI] 71% to 86%), specificity 316/331 (95%; 95% CI 93% to 97%), positive predictive value 92/107 (86%; 95% CI 78% to 92%), and negative predictive value 316/340 (93%; 95% CI 90% to 95%). The positive likelihood ratio was 15.8, and the negative likelihood ratio was 0.22. One hundred five (91%) of the 116 patients with intra-abdominal injuries and hemoperitoneum underwent a therapeutic laparotomy. Abdominal ultrasonography demonstrated intraperitoneal fluid in 87 (sensitivity 83%; 95% CI 74% to 90%) of these 105 patients.
Conclusion
Of patients with out-of-hospital or ED hypotension, abdominal ultrasonography identifies most patients with hemoperitoneum and intra-abdominal injuries. Hypotensive patients with negative abdominal ultrasonography results, however, must be further evaluated for sources of their hypotension, including additional abdominal evaluation, once they are hemodynamically stabilized.
aDivision of Emergency Medicine, University of California–Davis School of Medicine, Sacramento, CA, USA
bDepartment of Internal Medicine, University of California–Davis School of Medicine, Sacramento, CA, USA
cDepartment of Surgery, University of California–Davis School of Medicine, Sacramento, CA, USA
Address for correspondence: James F. Holmes, MD, Division of Emergency Medicine, University of California–Davis Medical Center, 2315 Stockton Boulevard, PSSB, Sacramento, CA 95817-2282; 916-734-1539, fax 916-734-7950
☆ Author contributions: JFH and DH conceived the study. JFH developed its design. JFH, DH, and FDB acquired the data; DH managed the data; and JFH analyzed and interpreted the data. JFH and FDB drafted the manuscript. All authors take responsibility for the paper as a whole.
Presented at the American College of Emergency Physicians Research Forum, Seattle, WA, October 2002.
The authors report this study did not receive any outside funding or support.
ABSTRACT