HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sirlin, C. B. Articles by Casola, G. Search for Related Content PubMed PubMed Citation Articles by Sirlin, C. B. Articles by Casola, G.

Screening US for Blunt Abdominal Trauma: Objective Predictors of False-Negative Findings and Missed Injuries¹

¹ From the Departments of Radiology (C.B.S., M.A.B., O.A.A.B., G.C.), Family and Preventive Medicine (R.D.), and Surgery (D.A.F., D.B.H.), University of California, San Diego, UCSD Medical Center, 200 W Arbor Dr, MC 8756, San Diego, CA 92103. Presented at the 2002 RSNA scientific assembly. Received February 20, 2003; revision requested May 14; revision received June 4; accepted July 23. R.D. supported in part by National Institutes of Health grant M01 RR00827. Address correspondence to C.B.S. (e-mail: csirlin@ucsd.edu).

PURPOSE: To determine the risk for missed injury in patients with blunt abdominal trauma and negative findings at screening ultrasonography (US) and with coexistent hematuria or fracture of the sixth through 12th ribs, lumbar spine, or pelvis.

MATERIALS AND METHODS: From a database of 4,000 patients screened with US for blunt abdominal trauma at a level 1 trauma center, the 3,679 patients with negative US findings were retrospectively classified by consensus of two authors into high-risk (n = 494) and low-risk (n = 3,185) groups based on the presence of hypothetical predictors of missed injury: hematuria (n = 96) or fracture of the sixth through 12th ribs (n = 216), lumbar spine (n = 105), or pelvis (n = 174). Outcome in each patient was determined by the same two authors consensually after retrospective review of the trauma registry and all radiologic, surgical, and autopsy reports. The risk for missed abdominal injury was determined for each patient risk group and for each hypothetical predictor. Risks were statistically compared by using the Pearson ², Fisher exact, or Fisher-Freeman-Halton exact test, depending on expected frequencies.

RESULTS: High-risk patients were 24 times more likely to have abdominal injuries after negative US findings (30 [6.1%] of 494) than were low-risk patients (eight [0.25%] of 3,185) (P < .001). Among high-risk patients, the absolute risks for missed abdominal injury associated with specific predictors were 15.6% (15 of 96 patients) for hematuria, 6.0% (13 of 216) for lower rib fractures, 7.6% (eight of 105) for lumbar spine fractures, and 5.2% (nine of 174) for pelvic fractures. Each of these risks was significantly higher for patients in the high-risk group than for those in the low-risk group (P < .001).

CONCLUSION: Hematuria and fracture of the lower ribs, lumbar spine, or pelvis are objective predictors of missed abdominal injury in patients with blunt abdominal trauma and negative US findings, and such patients may benefit from additional screening with computed tomography.

© RSNA, 2003

Index terms: Abdomen, injuries, 66.761, 70.41, 81.4134 • Abdomen, US, 70.1298 • Emergency radiology • Trauma, **.41²

This article has been cited by other articles:

				B. C. Lee, E. L. Ormsby, J. P. McGahan, G. M. Melendres, and J. R. Richards The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy Am. J. Roentgenol., February 1, 2007; 188(2): 415 - 421. [Abstract] [Full Text] [PDF]

				T. G. ODLE Blunt Pelvic Trauma Radiol. Technol., January 1, 2006; 77(3): 200 - 219. [Abstract] [Full Text] [PDF]

				N. Farahmand, C. B. Sirlin, M. A. Brown, G. P. Shragg, D. Fortlage, D. B. Hoyt, and G. Casola Hypotensive Patients with Blunt Abdominal Trauma: Performance of Screening US Radiology, May 1, 2005; 235(2): 436 - 443. [Abstract] [Full Text] [PDF]

				M. A. Brown, C. B. Sirlin, N. Farahmand, D. B. Hoyt, and G. Casola Screening Sonography in Pregnant Patients With Blunt Abdominal Trauma J. Ultrasound Med., February 1, 2005; 24(2): 175 - 181. [Abstract] [Full Text] [PDF]

				G. T. Shaw, C. B. Sirlin, M. A. Brown, R. Deutsch, O. A. Andrade-Barreto, D. Fortlage, D. B. Hoyt, and G. Casola The Golden Hour: How to Spend Your Time and Money in Trauma Radiology * Dr Sirlin and colleagues respond: Radiology, August 1, 2004; 232(2): 622 - 624. [Full Text] [PDF]