Blunt abdominal trauma: a prospective study with selective peritoneal lavage.

To determine the effectiveness of clinical evaluation and peritoneal lavage in blunt abdominal trauma, a prospective study was undertaken in 315 consecutive patients suspected of having this injury. Conscious patients with obvious physical findings were operated on without peritoneal lavage, and a diagnostic accuracy of 96% was achieved. In patients with altered states of consciousness, peritoneal lavage was studied prospectively for equivocal physical findings. An overall accuracy of 97% was achieved in such patients by peritoneal lavage. Peritoneal lavage was helpful in reducing the rate of normal findings at laparotomy by 50% in patients with altered states of consciousness and equivocal physical findings. Patients with normal findings on peritoneal lavage and subsequent deterioration had normal findings at laparotomy, which points to the value of further evaluation in such patients before laparotomy is carried out. Mortality is ultimately determined by the severity of the injury, despite early and definitive diagnosis and aggressive management.