Holmes James F, Harris Dawn, Battistella Felix D
Department of Internal Medicine, University of California-Davis School of Medicine, Sacramento, CA 95817-2282, USA.
Ann Emerg Med. 2004 Mar;43(3):354-61. doi: 10.1016/j.annemergmed.2003.09.011.
We determine the test performance of abdominal ultrasonography for detecting hemoperitoneum in blunt trauma patients with out-of-hospital or emergency department (ED) hypotension.
We reviewed the medical records of all blunt trauma patients hospitalized at a Level I trauma center. Patients were included if they were older than 6 years and had out-of-hospital or ED hypotension (systolic blood pressure < or =90 mm Hg) and underwent ED ultrasonography. The initial interpretation of the abdominal ultrasonography was recorded, including the presence or absence of intraperitoneal fluid and the specific location of such fluid. Presence or absence of intra-abdominal injury was determined by abdominal computed tomography scan, laparotomy, or clinical follow-up.
Four hundred forty-seven patients with a mean age of 36.0+/-17.5 years were enrolled. One hundred forty-eight (33%) patients had intra-abdominal injuries, and 116 (78%) of these patients had hemoperitoneum. Abdominal ultrasonography had the following test performance for detecting patients with intra-abdominal injury and hemoperitoneum: sensitivity 92/116 (79%; 95% confidence interval [CI] 71% to 86%), specificity 316/331 (95%; 95% CI 93% to 97%), positive predictive value 92/107 (86%; 95% CI 78% to 92%), and negative predictive value 316/340 (93%; 95% CI 90% to 95%). The positive likelihood ratio was 15.8, and the negative likelihood ratio was 0.22. One hundred five (91%) of the 116 patients with intra-abdominal injuries and hemoperitoneum underwent a therapeutic laparotomy. Abdominal ultrasonography demonstrated intraperitoneal fluid in 87 (sensitivity 83%; 95% CI 74% to 90%) of these 105 patients.
Of patients with out-of-hospital or ED hypotension, abdominal ultrasonography identifies most patients with hemoperitoneum and intra-abdominal injuries. Hypotensive patients with negative abdominal ultrasonography results, however, must be further evaluated for sources of their hypotension, including additional abdominal evaluation, once they are hemodynamically stabilized.
我们确定腹部超声检查对检测院外或急诊科（ED）低血压的钝性创伤患者腹腔积血的检测性能。
我们回顾了在一级创伤中心住院的所有钝性创伤患者的病历。纳入年龄大于6岁、院外或急诊科低血压（收缩压≤90mmHg）且接受急诊科超声检查的患者。记录腹部超声检查的初始解读结果，包括腹腔内有无液体及其具体位置。腹腔内损伤的有无通过腹部计算机断层扫描、剖腹手术或临床随访确定。
共纳入447例患者，平均年龄36.0±17.5岁。148例（33%）患者有腹腔内损伤，其中116例（78%）有腹腔积血。腹部超声检查对检测腹腔内损伤和腹腔积血患者的性能如下：敏感性92/116（79%；95%置信区间[CI]71%至86%），特异性316/331（95%；95%CI 93%至97%），阳性预测值92/107（86%；95%CI 78%至92%），阴性预测值316/340（93%；95%CI 90%至95%）。阳性似然比为15.8，阴性似然比为0.22。116例有腹腔内损伤和腹腔积血的患者中有105例（91%）接受了治疗性剖腹手术。腹部超声检查显示这105例患者中有87例（敏感性83%；95%CI 74%至90%）有腹腔内液体。
在院外或急诊科低血压患者中，腹部超声检查可识别出大多数有腹腔积血和腹腔内损伤的患者。然而，腹部超声检查结果为阴性的低血压患者，一旦血流动力学稳定后必须对其低血压的原因进行进一步评估，包括额外的腹部评估。
