The role of clinical and sonographic assessments in pre-operative evaluation of patients with splenic injuries in a resource-limited economy.

Abstract

Splenic trauma has been recognized as the most common cause of preventable deaths amongst trauma patients. Due to paucity of modern diagnostic imaging facilities in our setting, determination of the error rates and role of the simple, available diagnostic approaches are worthwhile and relevant to the practice of general surgery. The aim was to determine the role and diagnostic accuracy of clinical and sonographic assessments of splenic injuries. This was a prospective study of the value of pre-operative clinical and sonographic assessments of patients with splenic injuries in our setting. A total of 111 patients with abdominal trauma were evaluated. Of these, splenic injuries were confirmed in 75 patients intra-operatively, mainly from blunt trauma. Of the 97 cases diagnosed by clinical method, 66(68.0%) were confirmed by intraoperative findings. Similarly, of 86 sonographic diagnoses of splenic injuries, 61 (70.9%) truly had splenic trauma. Sensitivity for sonographic and clinical assessments was 84.7% and 78.9% respectively. False positive and negative rates for clinical (27.3% versus 44.1%) and ultrasonographic (29.1% versus 40.0%) assessments were high. Majority of splenic injuries were due to blunt abdominal trauma. The two diagnostic methods showed high sensitivity, but performed poorly for other validity tests.