Diagnostic peritoneal lavage in blunt trauma patients with coagulopathy

Abstract

Coagulopathies such as dilutional coagulopathy secondary to massive crystalloid and/or blood resuscitation, and disseminated intravascular coagulation secondary to head injury, complicate the care of severely traumatized patients. The accuracy of diagnostic peritoneal lavage has not been appraised in patients with coagulopathy. During a 3-year period, 847 patients underwent diagnostic peritoneal lavage using the direct visualization, open method. Exploratory laparotomy was performed on 298 patients for a positive diagnostic peritoneal lavage. All patients had coagulation studies prior to diagnostic peritoneal lavage. Twenty-eight patients (9.4%) with a mean injury severity score of 45, had coagulopathy prior to diagnostic peritoneal lavage. Only 2% (6/298) of the diagnostic peritoneal lavages were falsely positive despite the presence of pelvic fractures in 24.5% (73/298) of the patients. The incidence of falsely positive diagnostic peritoneal lavage was similar (P = .5) for patients with coagulopathy (3.6%, 1/28) as compared to patients without coagulopathy (1.8%, 5/272). Following blunt trauma, clinical indications for diagnostic peritoneal lavage do not mandate coagulation screening because diagnostic peritoneal lavage is reliable in patients with preexisting coagulopathy.