Diagnostic Peritoneal Lavage – A Lost Art? A Retrospective Observational Study at a Canadian Tertiary Trauma Centre

Abstract

INTRODUCTION: Abdominal trauma is a leading cause of morbidity and mortality in the young, adult patient in North America. The standard tools to assess the severity of abdominal trauma have been evolving. The continuing role of diagnostic peritoneal lavage (DPL) as a clinical tool to evaluate intra-abdominal injury today remains controversial. This study investigated trends in the use of DPL, CT (computerized tomography) and FAST (Focused Assessment with Sonography for Trauma) in trauma patients in the province of Nova Scotia’s single adult tertiary trauma centre. METHODS: We conducted a retrospective analysis of all patients over the age of 15 with severe blunt and/or penetrating abdominal trauma from 1996 to 2001 who presented to a tertiary care hospital in Nova Scotia. Patients included in this study were those with an injury severity score (ISS) of ≥9 for penetrating trauma and ≥12 for blunt trauma and were derived from the Nova Scotia Trauma Registry. Descriptive statistics were utilized to determine trends over the six year period. RESULTS: Of 172 patients included in the final cohort, the majority were male and under the age of 50. Blunt abdominal injury was far more common than penetrating abdominal injury in this cohort. Abdominal CT, FAST, and DPL were performed in 43.6%, 19.8% and 0.6% of the patients respectively. Absolute numbers of CTs and ultrasounds performed for abdominal trauma increased; however, the percentage of patients receiving those investigations remained constant. DISCUSSION: Despite having excellent published test characteristics and extensive literature supporting its use, DPL is not commonly used today to assess blunt/penetrating abdominal injury in major trauma patients in Nova Scotia’s tertiary trauma centre. These trends may have implications for guideline formulation for care of the major trauma patient with suspected intra-abdominal injuries.