The place of US for the diagnosis of clinically suspected abdominal bleeding in trauma patients

Abstract

Aims and Objectives: The detection of liquid collections remains a challenge for the trauma team, especially when there is multiple trauma. We present our experience in the diagnosis, follow-up and planning therapy of free and encapsulated abdominal liquid collections by performing ultrasound examination. Methods: 143 emergency trauma patients /116 male and 27 female/ were examined using ultrasound for a period of 2 years. The right and left oblique and propositioning view was used for US examination to identify free and bounded liquid collections in the abdominal cavity. The examination was performed immediately after the initial clinical survey with patients supine. Positive findings of liquid collections on US were compared with those provided by CT, punctures under US control or surgery. US machine supplied with 3.5 and 7 MHz linear and convex transducers, MDCT device, needles and catheters were used. Results: One hundred and fifteen /80.41%/ of all 143 US examined trauma patients had free and encapsulated liquid collections, confirmed by CT scan, surgery, or clinical course. In 59 /51.30%/ patients we performed fine needle puncture under US control. There were 95 true-positives, 14 true-negatives, 2 false-positives and fore false-negative results. Overall this demonstrated that ultrasonography had a sensitivity of 95.95%, specificity of 87.50% and accuracy of 94.78%. The PPV is 97.93% and the NPV – 77.77%. Conclusion: Our experience and literature reports support the opinion that US examination should be used as a primary method for diagnosis and follow-up of abdominal liquid collections in emergency patients.