Tayal Vivek S, Nielsen Amie, Jones Alan E, Thomason Michael H, Kellam James, Norton H James
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA.
J Trauma. 2006 Dec;61(6):1453-7. doi: 10.1097/01.ta.0000197434.58433.88.
Trauma ultrasound (US) utilizing the focused assessment with sonography in trauma (FAST) is often performed to detect traumatic free peritoneal fluid (FPF). Yet its accuracy is unclear in certain trauma subgroups such as those with major pelvic fractures whose emergent diagnostic and therapeutic needs are unique. We hypothesized that in patients with major pelvic injury (MPI) trauma ultrasound would perform with lower accuracy than has previously been reported.
Retrospective analysis of adult trauma patients with pelvic fractures seen at an urban Level I emergency department and trauma center. Patients were identified from the institutional trauma registry and ultrasound database from 1999 to 2003. All patients aged >16 years with MPI (Tile classification A2, all type B and C pelvic fractures, and type C acetabular fractures determined by a blinded orthopedic traumatologist) and who had a trauma US performed during the initial emergency department evaluation were included. All ultrasounds were performed by emergency physicians or surgeons using the four-quadrant FAST evaluation. Results of US were compared with one of three reference standards: abdominal/pelvic computed tomography, diagnostic peritoneal tap, or exploratory laparotomy. Two-by-two tables were constructed for diagnostic indices.
In all, 96 patients were eligible; 9 were excluded for indeterminate ultrasound results. Of the remaining 87 patients, the pelvic fracture types were distributed as follows: 9% type A2, 72% type B, 16% type C, and 3% type C acetabular fractures. Overall US sensitivity for detection of FPF was 80.8%, specificity was 86.9%, positive predictive value was 72.4%, and negative predictive value was 91.4%. Categorization of sensitivity according to pelvic ring fracture type is as follows: type A2 fractures: sensitivity and specificity, 75.0%; type B fractures: sensitivity, 73.3%, specificity, 85.1%; and type C fractures (pelvis and acetabulum): sensitivity and specificity, 100%. Of the true-positive US results, blood was the FPF in 16 of 21 (76%) and urine from intraperitoneal bladder rupture in 4 in 21 (19%) patients.
US in the initial evaluation of traumatic peritoneal fluid in major pelvic injury patients has lower sensitivity and specificity than previously reported for blunt trauma patients. Additionally, uroperitoneum comprises a substantial proportion of traumatic free peritoneal fluid in patients with MPI.
创伤超声（US）利用创伤重点超声评估（FAST）常常用于检测创伤性游离腹腔积液（FPF）。然而，在某些创伤亚组中，如那些有严重骨盆骨折且紧急诊断和治疗需求独特的患者，其准确性尚不清楚。我们推测，在严重骨盆损伤（MPI）患者中，创伤超声的准确性会低于先前报道的水平。
对一家城市一级急诊科和创伤中心收治的成年骨盆骨折创伤患者进行回顾性分析。从1999年至2003年的机构创伤登记册和超声数据库中识别患者。纳入所有年龄大于16岁、患有MPI（Tile分类A2型、所有B型和C型骨盆骨折以及由一名不知情的骨科创伤专家确定的C型髋臼骨折）且在急诊科初始评估期间接受过创伤超声检查的患者。所有超声检查均由急诊医生或外科医生采用四象限FAST评估法进行。将超声检查结果与以下三种参考标准之一进行比较：腹部/盆腔计算机断层扫描、诊断性腹腔穿刺或剖腹探查术。构建二乘二列联表以计算诊断指标。
共有96例患者符合条件；9例因超声检查结果不确定而被排除。在其余87例患者中，骨盆骨折类型分布如下：A2型9%，B型72%，C型16%，C型髋臼骨折3%。总体而言，超声检测FPF的敏感性为80.8%，特异性为86.9%，阳性预测值为72.4%，阴性预测值为91.4%。根据骨盆环骨折类型划分的敏感性如下：A2型骨折：敏感性和特异性均为75.0%；B型骨折：敏感性为73.3%，特异性为85.1%；C型骨折（骨盆和髋臼）：敏感性和特异性均为100%。在超声检查结果为真阳性的患者中，21例中有16例（76%）的FPF为血液，21例中有4例（19%）为腹膜内膀胱破裂导致的尿液。
在严重骨盆损伤患者中，超声在创伤性腹腔积液初始评估中的敏感性和特异性低于先前报道的钝性创伤患者。此外，在MPI患者中，尿腹占创伤性游离腹腔积液的很大比例。
