Ultrasound in Diagnosing Torso Injuries

• Authors: Piotr Budzyński , Marek Kuliś , Leszek Brongel , Marek Trybus , Waldemar Hładki
• Languages of publication: EN

Abstracts

EN

In patients with torso injuries, especially the ones with suspicion of injuries of intraabdominal organs, prompt making of diagnosis and decision about further management plays crucial role. Nowadays ultrasound is the first imaging technique used in Emergency Room in such cases.The aim of the study. Assessment of the value of ultrasound in diagnostics of patients with torso injuries, especially in qualification for operative or conservative treatment.Material and methods. 808 patients with an average age of 44.92 with torso injuries treated in the Department of Emergency Medicine and Multiple Injuries of 2nd Chair of General Surgery, Medical College of Jagiellonian University from 2004 to 2008, in whom ultrasound according to FAST protocol was used were included in the study. Results of sonographic examinations were verified during surgical operation (in patients treated surgically), or with the use of computed tomography (in patients treated conservatively), or on the basis of post-mortem examination (in patients who died due to sustained injuries), or on the basis of clinical course of hospitalization.Results. Sensitivity of ultrasound in the study material amounted to 90.43%, while specificity as much as 99.44%. Positive predictive value (so percentage of patients with truly positive result amongst the patients with positive result of diagnostic test) for whole study material was 95.5 while negative predictive value was 98.75.Conclusion. Results of the study confirm that ultrasound constitutes imaging technique of unique value in diagnostics of patients suffering from torso injuries, especially the circulatory unstable ones, allowing for precise qualification for prompt surgery.

Keywords

EN

ultrasound; torso injuries; imaging studies

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 11
• Pages: 497-502

Dates

published

1 - 11 - 2009

online

24 - 12 - 2009

Contributors

author

Piotr Budzyński

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Marek Kuliś

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Leszek Brongel

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Marek Trybus

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

author

Waldemar Hładki

• Department of Emergency Medicine and Multiple Trauma, 2 Chair of General Surgery, Medical College Jagiellonian University in Cracow

References

• Brongel L: Ciężkie mnogie i wielonarządowe obrażenia ciała: zasady postępowania. Przegl Lek 2003; 60 suppl 7: 56-62.
• Cirera E, Plasencia A, Ferrando J et al.: Factors associated with severity and hospital admission of motor-vehicle injury cases in a southern European urban area. Eur J Epidemiol 2001; 17(3): 201-08.[Crossref]
• MacLeod J, Lynn M, McKenney MG et al.: Predictors of mortality in trauma patients. Am Surg 2004; 70(9): 805-10.[PubMed]
• Kristensen JK, Buemann B, Kuhl E: Ultrasonic scanning in the diagnosis of splenic haematomas. Acta Chir Scand 1971; 137(7): 653-57.[PubMed]
• Brown MA, Casola G, Sirlin CB et al.: Blunt abdominal trauma: screening us in 2,693 patients. Radiology 2001; 218(2): 352-58.
• Farahmand N, Sirlin CB, Brown MA et al.: Hypotensive patients with blunt abdominal trauma: performance of screening US. Radiology 2005; 235(2): 436-43.[PubMed][Crossref]
• Lingawi SS, Buckley AR: Focused abdominal US in patients with trauma. Radiology 2000; 217(2): 426-29.
• Miller MT, Pasquale MD, Bromberg WJ et al.: Not so FAST. J Trauma 2003; 54(1): 52-9; discussion 59-60.[Crossref]
• Radwan MM, Abu-Zidan FM: Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective. Afr Health Sci 2006; 6(3): 187-90.
• Valentino M, Serra C, Zironi G et al.: Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 2006; 186(5): 1361-67.[Crossref]
• Brongel L: Postępy w diagnostyce mnogich obrażeń ciała. Nowiny Lekarskie 2007; suplement I: 45-46.
• Brongel L, Budzyński P: Uwarunkowania i zagrożenia w leczeniu chorych z obrażeniami ciała w stanach terminalnych. Pol Przegl Chir 2007; 79(7): 843-47.
• Brongel L, Hładki WA, Jarzynowski W i wsp.: Wybrane zagadnienia w postępowaniu w obrażeniach jamy brzusznej. Pol Przegl Chir 2007; 79(5): 836-51.
• Brenchley J, Walker A, Sloan JP et al.: Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J 2006; 23(6): 446-48.[PubMed][Crossref]
• McGahan JP, Richards J, Gillen M: The focused abdominal sonography for trauma scan: pearls and pitfalls. J Ultrasound Med 2002; 21(7): 789-800.[PubMed]
• Sirlin CB, Brown MA, Andrade-Barreto OA et al.: Blunt abdominal trauma: clinical value of negative screening US scans. Radiology 2004; 230(3): 661-68.[Crossref][PubMed]
• Grodziński T, Gackowski W, Hevelke P i wsp.: Przydatność ultrasonografii w diagnostyce skutków tępych urazów tułowia. Pol Przegl Chir 2003; 75(11): 1080-92.
• Dolich MO, McKenney MG, Varela JE et al.: 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001; 50(1): 108-12.
• Rozycki GS, Pennington SD, Feliciano DV: Surgeon-performed ultrasound in the critical care setting: its use as an extension of the physical examination to detect pleural effusion. J Trauma 2001; 50(4): 636-42.[PubMed][Crossref]
• Yoshii H, Sato M, Yamamoto S et al.: Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma 1998; 45(1): 45-50; discussion 50-51.[Crossref]
• Bode PJ, Edwards MJ, Kruit MC et al.: Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol 1999; 172(4): 905-11.[Crossref]
• Hsu JM, Joseph AP, Tarlinton LJ et al.: The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service. Injury 2007; 38(1): 71-75.[WoS][PubMed][Crossref]
• Lee BC, Ormsby EL, McGahan JP et al.: The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol 2007; 188(2): 415-21.[PubMed][Crossref]
• Richards JR, Schleper NH, Woo BD et al.: Sonographic assessment of blunt abdominal trauma: a 4-year prospective study. J Clin Ultrasound 2002; 30(2): 59-67.
• Salera D, Argalia G, Giuseppetti GM: Screening US for blunt abdominal trauma: a retrospective study. Radiol Med (Torino) 2005; 110(3): 211-20.[PubMed]
• Holmes JF, Harris D, Battistella FD: Performance of abdominal ultrasonography in blunt trauma patients with out-of-hospital or emergency department hypotension. Ann Emerg Med 2004; 43(3): 354-61.[PubMed][Crossref]
• Moylan M, Newgard CD, Ma OJ et al.: Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med 2007; 33(3): 265-71.[Crossref][WoS][PubMed]
• Udobi KF, Rodriguez A, Chiu WC et al.: Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 2001; 50(3): 475-79.[Crossref][PubMed]
• Ciesielczyk B, Kolenda M, Szymaniak M: Wartość diagnostyczna badania ultrasonograficznego i płukania otrzewnej w mnogich obrażeniach ciała. Pol Przegl Chir 2002; 74 (8): 700.
• Bakker J, Genders R, Mali W et al.: Sonography as the primary screening method in evaluating blunt abdominal trauma. J Clin Ultrasound 2005; 33(4): 155-63.[Crossref]
• Nural MS, Yardan T, Guven H et al.: Diagnostic value of ultrasonography in the evaluation of blunt abdominal trauma. Diagn Interv Radiol 2005; 11(1): 41-44.[PubMed]
• Huang MS, Liu M, Wu JK et al.: Ultrasonography for the evaluation of hemoperitoneum during resuscitation: a simple scoring system. J Trauma 1994; 36(2): 173-77.[PubMed][Crossref]
• Rose JS, Richards JR, Battistella F et al.: The fast is positive, now what? Derivation of a clinical decision rule to determine the need for therapeutic laparotomy in adults with blunt torso trauma and a positive trauma ultrasound. J Emerg Med 2005; 29(1): 15-21.[Crossref][PubMed]
• Philipp MO, Kubin K, Hormann M et al.: Radiological emergency room management with emphasis on multidetector-row CT. Eur J Radiol 2003; 48(1): 2-4.[Crossref]
• Shanmuganathan K: Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 2004; 25(2): 180-204.[Crossref][PubMed]
• Anderson SW, Lucey BC, Rhea JT et al.: 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol 2007; 14(3): 151-59.
• Marmery H, Shanmuganathan K, Alexander MT et al.: Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 2007; 189(6): 1421-27.[PubMed][Crossref]
• Marmery H, Shanmuganathan K, Mirvis SE et al.: Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg 2008; 206(4): 685-93.
• Fang JF, Wong YC, Lin BC et al.: Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg 2006; 30(2): 176-82.[Crossref][PubMed]
• Ibirogba S, Nicol AJ, Navsaria PH: Screening helical computed tomographic scanning in haemodynamic stable patients with transmediastinal gunshot wounds. Injury 2007; 38(1): 48-52.[Crossref][WoS]
• Shanmuganathan K, Mirvis SE, Chiu WC et al.: Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury - a prospective study in 200 patients. Radiology 2004; 231(3): 775-84.[Crossref]
• Brofman N, Atri M, Hanson JM et al.: Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 2006; 26(4): 1119-31.[PubMed][Crossref]

Identifiers

DOI

10.2478/v10035-009-0081-2