Sonography as the primary screening method in evaluating blunt abdominal trauma

The radiological evaluation of patients with blunt abdominal trauma can be done with either ultrasound (US) or computed tomography (CT) with strategies varying considerably among institutions. We evaluated the efficacy of our current strategy in which US is used at our hospital as the primary screening tool for patients with blunt abdominal trauma.

We retrospectively analysed all patients admitted to our hospital with possible blunt abdominal trauma who underwent abdominal US, abdominal CT and/or a laparotomy during the initial trauma assessment from 1998 until 2002 (n = 1149).

Nine-hundred sixty-one of the 1149 patients had a negative US, of which 922 were true negative, resulting in a negative predictive value of 96%. A CT of the abdomen was performed in 7%. In 1.7% there was delayed diagnosis with no significant additional morbidity. Fourteen of the 103 laparotomies (14%) were non-therapeutic; in 5 of these cases the patients underwent non-therapeutic laparotomy despite the performance of a CT. Seven were emergency operations.

In our practice, the use of US for the evaluation of acute blunt abdominal trauma is adequate, with a high negative predictive value, a small number of delayed diagnoses, and an acceptable rate of non-therapeutic laparotomies.