Emergency Ultrasound Predicting the Need for Therapeutic Laparotomy among Blunt Abdominal Trauma Patients in a Sub-Saharan African Hospital

P C M Musiitwa,M Galukande,H Wanzira,S Bugeza,R Wangoda

doi:10.1155/2014/793437

Abstract

Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient's evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC. Results. In total, 195 patients were evaluated; M : F ratio was 6 : 1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%. Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings.

Highlights

Trauma burden globally is on the increase accounting for high levels of mortality and morbidity
A total of 195 trauma patients clinically suspected to have sustained Blunt abdominal trauma (BAT) were subjected to emergency ultrasound scanning and were SSORTT scored at the A&E unit of Mulago Hospital from December 2012 to April 2013
Patients had a no suspected blunt abdominal trauma patients suspected to have blunt abdominal trauma patients were excluded: ∙ 1 was unable to be scored, due to poor scan images ∙ 5 were lost to followup patients were included in the study and underwent both standards of care and were SSORTT scored patients underwent laparotomy patients had nonoperative management

Summary

Introduction

Trauma burden globally is on the increase accounting for high levels of mortality and morbidity. It is the second largest single cause of disease accounting for 16%, only second to parasitic and infectious diseases at 23%. Blunt abdominal trauma (BAT) is injury to intraabdominal or retroperitoneal viscera as a result of a nonpenetrating force. The trauma burden globally accounts for high levels of mortality and morbidity. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings

Objectives

Methods

Results

Conclusion