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Blunt Abdominal Trauma: Clinical Value of Negative Screening US Scans¹

¹ From the Departments of Radiology (C.B.S., M.A.B., O.A.A., G.C.), Family and Preventive Medicine (R.D.), and Surgery (D.A.F., D.B.H.), University of California, San Diego Medical Center, 200 W Arbor Dr, MC 8756, San Diego, CA 92103-8756. From the 2000 RSNA scientific assembly. Received December 17, 2002; revision requested February 27, 2003; final revision received August 5; accepted August 22. R.D. supported in part by National Institutes of Health grant M01 RR00827. Address correspondence to C.B.S. (e-mail: csirlin@ucsd.edu).

View larger version (18K): [in a new window]   Figure 1. Schema summarizes findings at screening US in 3,679 patients. The sum of the percentages of surgical (Surg. [injuries that required surgical intervention]) and nonsurgical (N-S. [injuries that were treated successfully without intervention or were considered minor at autopsy]) false-negative findings (FN's) exceeds the percentage of total false-negative findings because of rounding. TN's = true-negative findings.

View larger version (33K): [in a new window]   Figure 2. Bar graph depicts true-negative (black bars) and false-negative (gray bars) findings at screening US each year. Numbers on the bars are the percentage of patients. Numbers in parentheses are the number of patients who underwent screening US. True- and false-negative rates were uniform throughout the study period.

View larger version (25K): [in a new window]   Figure 3. Graph depicts true-negative (black bars) and false-negative (gray bars) findings at screening US according to time of study. Numbers on the bars are the percentage of patients. The n values are the number of patients who underwent screening US. True- and false-negative rates were unaffected by the time of day when the studies were performed.

View larger version (29K): [in a new window]   Figure 4. Bar graph depicts the number of additional tests (gray bars) ordered in 3,641 patients with true-negative US findings each year. The tendency to order additional tests was significantly higher in the 1st year of the study than that in any of the subsequent years (P < .001). Numbers on the bars are the percentage of patients. Numbers in parentheses are the number of tests with true-negative findings. Black bars = no additional tests.

View larger version (178K): [in a new window]   Figure 5a. Images in an 18-year-old woman after a motor vehicle accident, with normal screening US findings. (a) Transverse screening US scan in right upper quadrant obtained with 3-MHz transducer shows no sonographic abnormality. L = liver. K = kidney. (b) Transverse follow-up contrast material-enhanced (ioversol, Optiray 320 [125 mL]; Mallinckrodt, St Louis, Mo) abdominal CT scan obtained at 31 hours after a to evaluate increasing abdominal pain shows small liver laceration (arrow) with no hemoperitoneum.

View larger version (163K): [in a new window]   Figure 5b. Images in an 18-year-old woman after a motor vehicle accident, with normal screening US findings. (a) Transverse screening US scan in right upper quadrant obtained with 3-MHz transducer shows no sonographic abnormality. L = liver. K = kidney. (b) Transverse follow-up contrast material-enhanced (ioversol, Optiray 320 [125 mL]; Mallinckrodt, St Louis, Mo) abdominal CT scan obtained at 31 hours after a to evaluate increasing abdominal pain shows small liver laceration (arrow) with no hemoperitoneum.

View larger version (25K): [in a new window]   Figure 6. Bar graph depicts delay between screening US with false-negative findings and the diagnostic test that first indicated the missed injury. Injuries in 19 (50%) of the 38 patients were diagnosed within 12 hours, and those in 34 (89%) were diagnosed within 24 hours. Numbers on the bars are the number of patients.