The Value of Complete Ultrasonography Diagnosis in the Management of Selected Patients with Abdominal Trauma

Abstract

Patients who have sustained blunt abdominal trauma (BAT) pose a diagnostic challenge. Intraabdominal injuries may lead to increased morbidity and mortality. Abdominal computed tomography (CT) is the gold standard for identifying abdominal injuries, but is associated with radiation exposure and longer emergency hospital stay and increased health care costs. The aim of this study was to correlate the initial abdominal ultrasound (U/S) imaging findings with CT findings and clinical outcome in patients with BAT. The study population consisted of 61 adult trauma patients. The inclusion criteria were suspected BAT, hemodynamic stability and a score on the Glasgow coma scale (GCS) of ≥14. Patients requiring immediate surgical intervention were excluded. Of the 61 patients in the study, 18 (29.6%) were female and 43 (70.4%) were male, with a mean age of 54.8 years and 39.6 years, respectively. The mechanism of injury included: motor vehicle collision 16 (26.2%), motorcycle related 23 (37.7%), falls 18 (29.5%), pedestrian road traffic accident 3 (4.9%), and one (1.6%) assault. All the patients were hemodynamically stable, had a GCS ≥14 and had a suspicion of BAT. All the study patients underwent abdominal CT and U/S. The focused assessment with sonography (FAST) was negative for free fluid in 23 patients, in 9 of which minor visceral injuries were revealed on CT, but none needed surgical intervention. In 28 patients, free fluid or parenchymal injury was detected on abdominal U/S, which was confirmed on CT in 22 patients. In this group, 6/28 patients required surgical intervention due to clinical deterioration. Finally, when both fluid and parenchymal organ injuries were detected on U/S, the CT scan was positive in every case (10/10), but only 2 of these patients required surgical intervention. All of the study patients made a good recovery. Patients with BAT that meet certain clinical criteria and have a negative complete abdominal U/S imaging can be safely managed and discharged without the need for a CT scan.