Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture

Randall S Friese, Stephen Malekzadeh, Shahid Shafi, Larry M. Gentilello, Adam Starr

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

BACKGROUND: Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus pelvic angiography. The use of ultrasound (FAST [Focused Assessment with Sonography for Trauma]) for the evaluation of hemoperitoneum after blunt abdominal trauma has become widespread. However, its sensitivity and specificity in patients with pelvic fracture remain poorly defined. The purpose of this study was to determine the sensitivity and specificity of FAST for the detection of hemoperitoneum in patients with pelvic fracture and an increased risk for hemorrhage. METHODS: The medical records for all admissions to our Level I trauma center from November 2003 to February 2005 were retrospectively reviewed. Inclusion criteria were presence of pelvic fracture with at least one of the following risk factors for hemorrhage: age ≥55, hemorrhagic shock (systolic blood pressure <100 mm Hg), or unstable fracture pattern. Emergency department FAST results were recorded. Surgery residents trained and certified in ultrasonography in the acute setting performed all FAST examinations and an in house attending surgeon reviewed them. Presence of hemoperitoneum was confirmed by laparotomy or abdominopelvic computed tomography (CT) scan. RESULTS: There were 146 patients who met entry criteria, 126 of who had a FAST examination performed. A total of 104 patients underwent a confirmatory evaluation of their abdomen with either operative exploration (n = 20) or CT scan (n = 84). Eight patients underwent diagnostic peritoneal lavage before CT confirmation and were excluded. Ninety-six patients constituted the study group. Nineteen patients presented in hemorrhagic shock. There were 11 true-positive, 52 true-negative, 2 false-positive, and 31 false-negative results. Sensitivity and specificity were 26% and 96%, respectively. Positive and negative predictive values were 85% and 63%, respectively. CONCLUSIONS: A FAST examination with negative result does not aid in determining the need for laparotomy versus pelvic angiography in patients with pelvic fracture at risk for hemorrhage. These patients should undergo additional confirmatory evaluation to exclude intraperitoneal hemorrhage.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalJournal of Trauma
Volume63
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

Fingerprint

Hemoperitoneum
Laparotomy
Hemorrhage
Hemorrhagic Shock
Tomography
Sensitivity and Specificity
Ultrasonography
Angiography
Blood Pressure
Peritoneal Lavage
Trauma Centers
Wounds and Injuries
Abdomen
Medical Records
Hospital Emergency Service
Hemodynamics

Keywords

  • Abdominal ultrasonography
  • Hemorrhage
  • Pelvic fracture

ASJC Scopus subject areas

  • Surgery

Cite this

Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. / Friese, Randall S; Malekzadeh, Stephen; Shafi, Shahid; Gentilello, Larry M.; Starr, Adam.

In: Journal of Trauma, Vol. 63, No. 1, 07.2007, p. 97-102.

Research output: Contribution to journalArticle

Friese, Randall S ; Malekzadeh, Stephen ; Shafi, Shahid ; Gentilello, Larry M. ; Starr, Adam. / Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. In: Journal of Trauma. 2007 ; Vol. 63, No. 1. pp. 97-102.
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abstract = "BACKGROUND: Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus pelvic angiography. The use of ultrasound (FAST [Focused Assessment with Sonography for Trauma]) for the evaluation of hemoperitoneum after blunt abdominal trauma has become widespread. However, its sensitivity and specificity in patients with pelvic fracture remain poorly defined. The purpose of this study was to determine the sensitivity and specificity of FAST for the detection of hemoperitoneum in patients with pelvic fracture and an increased risk for hemorrhage. METHODS: The medical records for all admissions to our Level I trauma center from November 2003 to February 2005 were retrospectively reviewed. Inclusion criteria were presence of pelvic fracture with at least one of the following risk factors for hemorrhage: age ≥55, hemorrhagic shock (systolic blood pressure <100 mm Hg), or unstable fracture pattern. Emergency department FAST results were recorded. Surgery residents trained and certified in ultrasonography in the acute setting performed all FAST examinations and an in house attending surgeon reviewed them. Presence of hemoperitoneum was confirmed by laparotomy or abdominopelvic computed tomography (CT) scan. RESULTS: There were 146 patients who met entry criteria, 126 of who had a FAST examination performed. A total of 104 patients underwent a confirmatory evaluation of their abdomen with either operative exploration (n = 20) or CT scan (n = 84). Eight patients underwent diagnostic peritoneal lavage before CT confirmation and were excluded. Ninety-six patients constituted the study group. Nineteen patients presented in hemorrhagic shock. There were 11 true-positive, 52 true-negative, 2 false-positive, and 31 false-negative results. Sensitivity and specificity were 26{\%} and 96{\%}, respectively. Positive and negative predictive values were 85{\%} and 63{\%}, respectively. CONCLUSIONS: A FAST examination with negative result does not aid in determining the need for laparotomy versus pelvic angiography in patients with pelvic fracture at risk for hemorrhage. These patients should undergo additional confirmatory evaluation to exclude intraperitoneal hemorrhage.",
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T1 - Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture

AU - Friese, Randall S

AU - Malekzadeh, Stephen

AU - Shafi, Shahid

AU - Gentilello, Larry M.

AU - Starr, Adam

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N2 - BACKGROUND: Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus pelvic angiography. The use of ultrasound (FAST [Focused Assessment with Sonography for Trauma]) for the evaluation of hemoperitoneum after blunt abdominal trauma has become widespread. However, its sensitivity and specificity in patients with pelvic fracture remain poorly defined. The purpose of this study was to determine the sensitivity and specificity of FAST for the detection of hemoperitoneum in patients with pelvic fracture and an increased risk for hemorrhage. METHODS: The medical records for all admissions to our Level I trauma center from November 2003 to February 2005 were retrospectively reviewed. Inclusion criteria were presence of pelvic fracture with at least one of the following risk factors for hemorrhage: age ≥55, hemorrhagic shock (systolic blood pressure <100 mm Hg), or unstable fracture pattern. Emergency department FAST results were recorded. Surgery residents trained and certified in ultrasonography in the acute setting performed all FAST examinations and an in house attending surgeon reviewed them. Presence of hemoperitoneum was confirmed by laparotomy or abdominopelvic computed tomography (CT) scan. RESULTS: There were 146 patients who met entry criteria, 126 of who had a FAST examination performed. A total of 104 patients underwent a confirmatory evaluation of their abdomen with either operative exploration (n = 20) or CT scan (n = 84). Eight patients underwent diagnostic peritoneal lavage before CT confirmation and were excluded. Ninety-six patients constituted the study group. Nineteen patients presented in hemorrhagic shock. There were 11 true-positive, 52 true-negative, 2 false-positive, and 31 false-negative results. Sensitivity and specificity were 26% and 96%, respectively. Positive and negative predictive values were 85% and 63%, respectively. CONCLUSIONS: A FAST examination with negative result does not aid in determining the need for laparotomy versus pelvic angiography in patients with pelvic fracture at risk for hemorrhage. These patients should undergo additional confirmatory evaluation to exclude intraperitoneal hemorrhage.

AB - BACKGROUND: Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus pelvic angiography. The use of ultrasound (FAST [Focused Assessment with Sonography for Trauma]) for the evaluation of hemoperitoneum after blunt abdominal trauma has become widespread. However, its sensitivity and specificity in patients with pelvic fracture remain poorly defined. The purpose of this study was to determine the sensitivity and specificity of FAST for the detection of hemoperitoneum in patients with pelvic fracture and an increased risk for hemorrhage. METHODS: The medical records for all admissions to our Level I trauma center from November 2003 to February 2005 were retrospectively reviewed. Inclusion criteria were presence of pelvic fracture with at least one of the following risk factors for hemorrhage: age ≥55, hemorrhagic shock (systolic blood pressure <100 mm Hg), or unstable fracture pattern. Emergency department FAST results were recorded. Surgery residents trained and certified in ultrasonography in the acute setting performed all FAST examinations and an in house attending surgeon reviewed them. Presence of hemoperitoneum was confirmed by laparotomy or abdominopelvic computed tomography (CT) scan. RESULTS: There were 146 patients who met entry criteria, 126 of who had a FAST examination performed. A total of 104 patients underwent a confirmatory evaluation of their abdomen with either operative exploration (n = 20) or CT scan (n = 84). Eight patients underwent diagnostic peritoneal lavage before CT confirmation and were excluded. Ninety-six patients constituted the study group. Nineteen patients presented in hemorrhagic shock. There were 11 true-positive, 52 true-negative, 2 false-positive, and 31 false-negative results. Sensitivity and specificity were 26% and 96%, respectively. Positive and negative predictive values were 85% and 63%, respectively. CONCLUSIONS: A FAST examination with negative result does not aid in determining the need for laparotomy versus pelvic angiography in patients with pelvic fracture at risk for hemorrhage. These patients should undergo additional confirmatory evaluation to exclude intraperitoneal hemorrhage.

KW - Abdominal ultrasonography

KW - Hemorrhage

KW - Pelvic fracture

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