Sonographic examination of abdominal trauma by senior surgical residents

The focused ultrasound examination is assuming an important role in the evaluation of abdominal trauma. We evaluated the ability of senior surgical residents to independently use this technique. We also evaluated the efficacy of a single sonographic examination instead of serial examinations. Senior surgical residents underwent sonography instruction by two attending surgeons certified in the technique. Once proficiency was attained, a single sonographic examination was performed on patients with abdominal trauma triaged to a Level I trauma center. Residents obtained additional diagnostic studies deemed appropriate. Ultrasound results were compared with other diagnostic studies and clinical course. Sonography was performed on 518 patients between January 10, 1995 and June 30, 1996. Mechanism of injury was blunt in 92 per cent of patients and penetrating in 8 per cent. There were 22 true positives, 12 false positives, 8 false negatives, and 476 true negatives. Five of the eight false negatives were secondary to limited hollow viscus injuries with minimal associated intraperitoneal fluid. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 73.3, 97.5, 96.1, 64.7, and 98.3 per cent, respectively. The use of computed tomography and diagnostic peritoneal lavage decreased from 25 to 18 per cent and 3.2 to 0.2 per cent, respectively, as diagnostic tools. We conclude that surgical residents can competently perform trauma ultrasound. A single sonographic examination is effective and reliable. Sonography has essentially replaced diagnostic peritoneal lavage in our institution.