Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography

 

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Abstract

Purpose Patients suffering from severe blunt abdominal trauma are challenging because of their need for accurate diagnostic imaging and fast therapeutic action. Whole-body computed tomography (WBCT) is highly sensitive and represents the gold standard in the trauma room diagnostic setting. The aim of our study was to investigate the impact and therapy relevance of abdominal follow-up sonography (AFS) as part of the tertiary trauma survey (TTS) in patients without abdominal parenchymal organ lesions or free abdominal fluid in initial WBCT.

Materials and Methods All adult patients without abdominal parenchymal organ lesions or free intraabdominal fluid in the initial WBCT examination, who received AFS within 24 hours after trauma, were included in this retrospective analysis between January 2008 and December 2011.

Results 316 patients were analyzed (ISS 10 ± 8, NISS 13 ± 11) according to the inclusion criteria. Overall, only small amounts of free intraabdominal fluid were detected in AFS in 3 patients (0.9 %) and remained without therapeutic consequence. None of the patients died due to intraabdominal bleeding.

Conclusion AFS as part of the TTS did not show additional benefits and had no impact on further treatment in patients without abdominal parenchymal organ lesions or free intraabdominal fluid in the initial WBCT examination. We conclude that AFS is not routinely required but should be performed if indicated on a clinical or laboratory basis because of its fast and less invasive character.

Key points 

• Seriously injured patients are challenging for medical imaging and treatment.

• Whole-body computed tomography is known for its high accuracy in trauma patients.

• Nonetheless, missed injuries are a major challenge in trauma patients.

• Therefore, follow-up ultrasound is often performed within the tertiary trauma survey.

• Follow-up ultrasound in patients with an inconspicuous abdominal computed tomography scan did not show any benefit.

Citation Format

• Schneck E, Koch C, Borgards M et al. Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography. Fortschr Röntgenstr 2017; 189: 128 – 136

Zusammenfassung

Ziel Das Management von Patienten mit schwerem Bauchtrauma ist oft sehr schwierig und erfordert eine möglichst schnelle akkurate Bildgebung und Behandlung. Die Ganzkörper-Computertomografie (GK-CT) stellt den Goldstandard zur Diagnostik solcher Patienten dar. Ziel unserer Studie war es den Nutzen des Verlaufsultraschalls im Rahmen des „Tertiary Trauma Survey (TTS)“ bei Patienten ohne abdominelle Parenchymorganläsion oder freie Flüssigkeit im initialen GK-CT zu evaluieren.

Material und Methoden In die retrospektive Studie wurden zwischen Januar 2008 und Dezember 2011 alle erwachsenen Patienten ohne Parenchymorganläsion oder freie Flüssigkeit im initialen GK-CT, die einen Verlaufsultraschall innerhalb von 24 Stunden nach dem Trauma erhielten, eingeschlossen.

Ergebnisse Insgesamt 316 Patienten konnten für die Analyse herangezogen werden (ISS 10 ± 8, NISS 13 ± 11). Im Verlaufsultraschall zeigten sich bei lediglich 3 Patienten (0,9 %) sehr geringe Mengen an freier Flüssigkeit, welche aber ohne jegliche weitere therapeutische Konsequenz verblieben. Keiner der Patienten starb an einer intraabdominellen Blutung.

Schlussfolgerung Der Verlaufsultraschall im Rahmen des TTS zeigte keinen diagnostischen Nutzen und hatte keinen Einfluss auf Patientenfolgebehandlungen bei Traumapatienten ohne Nachweis einer Parenchymorganverletzung oder freier Flüssigkeit im initialen GK-CT. Somit schlussfolgern wir, das ein Verlaufsultraschall bei diesem Patientenkollektiv nicht routinemäßig durchgeführt werden sollte, aber jederzeit falls klinisch oder laborchemisch erforderlich auch aufgrund der geringen Invasivität und der schnellen Verfügbarkeit erfolgen kann.

Kernaussagen 

• Schwerverletzte Patienten stellen Bildgebung und Behandlung vor eine große Herausforderung.

• Die Ganzkörper-CT zeichnet sich bei Schwerstverletzten durch ihre hohe diagnostische Genauigkeit aus.

• Trotzdem stellen übersehene Befunde im CT eine große Herausforderung bei Schwerstverletzten dar.

• Im Rahmen des „Tertiary Trauma Survey“ wird deshalb häufig eine Verlaufsultraschalluntersuchung durchgeführt.

• Die Verlaufsultraschalluntersuchung zeigte bei Patienten mit unauffälliger abdomineller CT aber keinen zusätzlichen Nutzen.

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