Hepatic and Splenic Injuries
Hepatic and Splenic Injuries
Background. The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting free intraperitoneal fluid in trauma patients later diagnosed with hepatic or splenic injuries.
Methods. This retrospective study conducted over a 17-month period enrolled patients with trauma. A Focused Abdominal Sonogram for Trauma (FAST) examination was done using 5 abdominal views. Exploratory laparotomy or computed tomography (CT) confirmed the presence of intraperitoneal fluid and associated injuries. The sensitivity and specificity were determined.
Results. Of the 245 study patients, 29 had injuries to the liver or spleen or both. The 5-view FAST examination's sensitivity for detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 77%, 90%, and 100%, respectively. The sensitivity of the single Morison's pouch view in detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 38%, 20%, and 67%, respectively.
Conclusion. For identifying free intraperitoneal fluid associated with hepatic or splenic injuries, no single view of the FAST examination could match the sensitivity provided by the 5-view technique.
For the detection of hemoperitoneum, emergency physicians and trauma surgeons have reported the FAST examination to have a sensitivity ranging from 85% to 99% and a specificity ranging from 88% to 100%. Most studies have used a multiple view ultrasound examination for evaluation of trauma patients. Several investigators have used a single-view technique, examining only Morison's pouch for free intraperitoneal fluid. Rozycki et al reported that hemoperitoneum most often is located in the right upper quadrant, independent of solid organ injury, and recommended that the routine FAST examination begin with Morison's pouch.
For optimal ultrasonic screening in cases of intra-abdominal trauma, it remains debatable whether a single view of Morison's pouch, or any of the four other individual views, is as clinically useful for detecting hemoperitoneum as the full examination using multiple ultrasonic views of the abdomen. The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting the presence or absence of free intraperitoneal fluid in trauma patients later found to have hepatic or splenic injuries.
Background. The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting free intraperitoneal fluid in trauma patients later diagnosed with hepatic or splenic injuries.
Methods. This retrospective study conducted over a 17-month period enrolled patients with trauma. A Focused Abdominal Sonogram for Trauma (FAST) examination was done using 5 abdominal views. Exploratory laparotomy or computed tomography (CT) confirmed the presence of intraperitoneal fluid and associated injuries. The sensitivity and specificity were determined.
Results. Of the 245 study patients, 29 had injuries to the liver or spleen or both. The 5-view FAST examination's sensitivity for detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 77%, 90%, and 100%, respectively. The sensitivity of the single Morison's pouch view in detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 38%, 20%, and 67%, respectively.
Conclusion. For identifying free intraperitoneal fluid associated with hepatic or splenic injuries, no single view of the FAST examination could match the sensitivity provided by the 5-view technique.
For the detection of hemoperitoneum, emergency physicians and trauma surgeons have reported the FAST examination to have a sensitivity ranging from 85% to 99% and a specificity ranging from 88% to 100%. Most studies have used a multiple view ultrasound examination for evaluation of trauma patients. Several investigators have used a single-view technique, examining only Morison's pouch for free intraperitoneal fluid. Rozycki et al reported that hemoperitoneum most often is located in the right upper quadrant, independent of solid organ injury, and recommended that the routine FAST examination begin with Morison's pouch.
For optimal ultrasonic screening in cases of intra-abdominal trauma, it remains debatable whether a single view of Morison's pouch, or any of the four other individual views, is as clinically useful for detecting hemoperitoneum as the full examination using multiple ultrasonic views of the abdomen. The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting the presence or absence of free intraperitoneal fluid in trauma patients later found to have hepatic or splenic injuries.
