Role of ultrasonography in blunt abdominal trauma

Patients with blunt abdominal trauma (BAT) often have equivocal signs of intra-abdominal injury. Diagnostic peritoneal lavage (DPL) has been in the 'gold standard' for evaluating these patients, the use of ultrasound (US) being a recent phenomenon. Seventy-three patients with BAT and equivocal physical signs were subjected to both DPL and US for detection of intra-abdominal injury. Based on clinical status, DPL and US findings, the patients underwent laparotomy or non-operative management. DPL was positive in 35 patents. There was one false positive and one false negative result (sensitivity 97.1%, specificity 97.4%, accuracy 97.3%). US was positive in 31 patients. There were 5 false positive and 4 false negative results (sensitivity 86.7%, specificity 88.4%, accuracy 87.7%). Solid viscus injury was documented at laparotomy in 24 patients. DPL failed to detect one pancreatic injury, while US failed to detect 4 splenic and 2 liver injuries. US additionally detected a single case of haemopericardium. Although DPL outperformed US in this study, US can complement DPL in defining the organs injured and in follow up of patients undergoing non operative management for BAT.