McKenney M, Lentz K, Nunez D, Sosa J L, Sleeman D, Axelrad A, Martin L, Kirton O, Oldham C
University of Miami, School of Medicine, Florida.
J Trauma. 1994 Sep;37(3):439-41. doi: 10.1097/00005373-199409000-00018.
Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is fast and accurate but associated with complications. Computed tomography is also accurate, yet requires that patients be stable and transportable. A prospective study was designed to determine the utility of emergency ultrasound (US) studies in the initial assessment of BAT. Two hundred acutely injured patients with suspected BAT were evaluated with US. Patients were eligible for the study if they met trauma criteria and had suspected BAT. Subsequently, without knowledge of the US results, DPL or CT was performed. Ultrasound showed a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in detecting intra-abdominal injuries. Six injuries were missed but only one was felt to be significant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.
诊断性腹腔灌洗（DPL）和计算机断层扫描（CT）是评估疑似钝性腹部创伤（BAT）患者的主要诊断方法。诊断性腹腔灌洗快速且准确，但会伴有并发症。计算机断层扫描同样准确，但要求患者病情稳定且可转运。一项前瞻性研究旨在确定急诊超声（US）检查在BAT初始评估中的效用。对200例疑似BAT的急性受伤患者进行了超声检查。符合创伤标准且疑似BAT的患者有资格参与该研究。随后，在不知晓超声检查结果的情况下，进行了DPL或CT检查。超声在检测腹腔内损伤方面显示出83%的灵敏度、100%的特异性和97%的准确率。有6处损伤漏诊，但只有1处被认为是严重的。如果对所有200例患者都使用超声检查，199例患者将得到恰当的治疗。我们得出结论，超声在检测腹腔内游离液体方面是可靠的，可用于替代DPL或CT。
