Bruce Adams, MD, FACEP; Craig Sisson, MD, RDMS, FACEP
In adults with blunt abdominal trauma, what are the accuracies of clinical findings and bedside imaging for detecting intraabdominal injuries?
Included studies evaluated clinical history, physical examination, laboratory tests, and bedside imaging, including abdominal ultrasonography (Focused Assessment with Sonography for Trauma [FAST] examination), for detecting intraabdominal injuries in adults with blunt abdominal trauma. Studies had to include ≥ 1 of the following reference standards: abdominal computed tomography (CT), diagnostic peritoneal lavage, laparotomy, autopsy, or clinical course. Outcomes were sensitivity, specificity, and likelihood ratios.
MEDLINE and EMBASE/Excerpta Medica (to Jan 2012); reference lists; and for FAST studies, high-quality systematic reviews were searched for English-language studies. 33 studies met selection criteria: 12 evaluated clinical findings (n = 10 757); and 22 evaluated the FAST examination (n = 12 089), including 1 study that also evaluated clinical findings. 25 studies were done in US level 1 trauma centers. Only studies rated as level 1 (highest quality) or level 2 on the Rational Clinical Examination quality checklist (5 possible levels) were included in imaging analyses: 5 level 1 studies (n = 7476) and 17 level 2 studies (n = 4613). Level 3 studies were also included in analyses of clinical findings: 2 level 1 studies (n = 4149), no level 2 studies, and 7 level 3 studies (n = 1985).
The pooled prevalence of intraabdominal injuries in quality level 1 and 2 studies was 13% (95% CI 10 to 17). The diagnostic characteristics for findings and tests evaluated in > 1 study are shown in the Table. For clinical findings evaluated in single studies, test characteristics varied from 5% sensitivity (CI 0 to 10) and 99% specificity (CI 99 to 100) for rebound tenderness (n = 714) to 88% sensitivity (CI 78 to 95) and 95% specificity (CI 92 to 97) for base deficit < −6 mEq/L (n = 400).
The bedside Focused Assessment with Sonography for Trauma examination has 82% sensitivity and 99% specificity for detecting intraabdominal injuries in adults with blunt abdominal trauma; most clinical findings have poor sensitivity and moderate to high specificity.
Accuracy of clinical findings and imaging tests for detecting intraabdominal injuries in adults with blunt abdominal trauma*
*FAST = Focused Assessment with Sonography for Trauma examination; diagnostic terms defined in Glossary. Only findings and tests evaluated in > 1 study are reported in the Table.
Bruce Adams, Craig Sisson. Review: Bedside ultrasonography has 82% sensitivity and 99% specificity for blunt intraabdominal injury. Ann Intern Med. 2012;157:JC2–12. doi: 10.7326/0003-4819-157-4-201208210-02012
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Published: Ann Intern Med. 2012;157(4):JC2-12.
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