AYDIN ÜNAL, Pınar YAZICI, Alper UĞUZ, Sadık TAMSEL, İlhami SOLAK, Hasan KAPLAN

Travma hastalarında ultrasonografi ve bilgisayarlı tomografi sonuçlarının karşılaştırılması

Acil batın cerrahisi öncesi, yapılacak öncelikli fizik muayene ve takip eden ultrasonografi (US) hastada cerrahi açıdan önemli olabilecek sıvı teşhisinde önemlidir. Bu çalışmadaki amacımız ultrasonografinin travma hastalarındaki etkinliğini bilgisayarlı tomografi (BT) ile karşılaştırmalı olarak değerlendirmektir. Bir yıllık süre boyunca hastanemiz acil servisine başvuran hastalar retrospektif olarak tarandı. Hastaların demografik özellikleri, travma etiyolojileri, sonografik bulgular ve BT sonuçları değerlendirildi. US’da serbest sıvı ve parankimal organ hasarı varlığı denetlendi. Tespit edilen 4102 travma hastasından 306 (7.4 %) hastaya batın US uygulandı. Çalışma grubuna alınan 211 erkek ve 95 kadın hastanın yaş ortalaması 25.6 yıl bulundu. Travma etiyolojileri arasında trafik kazası % 66.9 oranı ile birinci sırayı almakla birlikte, diğer künt travmalar %26.6 ve penetran yaralanmalar %6.1 oranında gözlendi. Yapılan batın US sonrası 79 (%25.8) hastada serbest sıvı saptandı ve 15 olguya acil laparotomi uygulandı. Diğer hastalardan 19’una yalnızca batın ve geri kalanlara ise torakoabdominal BT uygulandı. US ve BT sonuç karşılaştırması, peritoneal lavaj ve operatif bulgulara göre yapıldığında, US ile 21 gerçek (+), 273 gerçek (-), 4 yalancı (+), 8 yalancı (-) sonuç saptandı. US’nin serbest sıvı tespitinde sensitivitesi %72, spesifitesi %97 ve doğruluk oranı %84 olarak bulundu. Acil servislerde travma hastalarına yaklaşımda US görüntüleme açısında ilk sırada uygulanabilir bir tetkik olsa da, hastanın travma mekanizması göz önünde bulundurularak ve klinik şüphe halinde BT ileri tetkik için ikinci yaklaşım olmalıdır.

Anahtar Kelimeler:

Karşılaştırmalı çalışma, Tomografi, x-ışınlı bilgisayarlı, Ultrasonografi, Acil tıp servisleri, Batın yaralanmaları

Comparison the results of ultrasonography with computed tomography of traumatized patients

Before emergent abdominal trauma surgery, abdominal evaluation with initial physical examination and subsequent ultrasonography (US) which focuses on detection of free fluid in the abdomen are sufficient to identify surgically significant abdominal injury in traumatized patients. In this study, we aimed to evaluate the efficacy of abdominal US compared to computed tomography (CT) in patients with abdominal trauma. In one- year period, the patients who were admitted to the Emergency Department with acute abdominal trauma were included in this study. Hospital records were retrospectively reviewed and demographic variables, the etiology of trauma, sonographic findings and results of computed tomography (CT) were checked. Ultrasonographic examination focused on detection of free fluid but included evaluation of parenchymal organs for injury, too. Of 4102 traumatized patients, 306 (7,4%) required abdominal US. There were 211 male and 95 female with a mean age of 25,6 years and etiologies were followed as: traffic accident 66,9%, blunt trauma 26,6%, and penetrating injury 6.1%. Abdominal US was revealed free fluid in 25,8% (n=79) patients and 15 cases underwent emergent laparotomy. Of the remaining patients, 19 were evaluated with abdominal tomography while others were performed both abdominal and thoracic tomography. In comparing US to CT, considering the diagnostic peritoneal lavage, or operative findings, we obtained 21 true positive, 273 true negative, 4 false positive, 8 false negative results. Sensitivity, specifity and accuracy of US in detecting free fluid in abdomen were 72%, 97%, and 84%, respectively. Although, US may be used for the first diagnostic study in the emergency service, in case of clinical suspicion, CT should be the second method for further investigation regarding the injury mechanism.

Keywords:

Comparative Study, Tomography, X-Ray Computed, Ultrasonography, Emergency Medical Services, Abdominal Injuries,

PDF

___

1. FAST Consensus Conference Committee. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 1999;46: 466–72.
2. Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995;38: 879–85.
3. Ballard RB, Rozycki GS, Newman PG, Cubillos JE, Salomone JP, Ingram WL, Feliciano DV. An algorithm to reduce the incidence of falsenegative FAST examinations in patients at high risk for occult injury. Focused Assessment for the Sonographic Examination of the Trauma patient. J Am Coll Surg. 1999;189: 145-50.
4. Farahmand N, Sirlin CB, Brown MA, Shragg GP, Fortlage D, et al. Hypotensive Patients with Blunt Abdominal Trauma: Performance of Screening US. Radiology 2005;235: 436–43.
5. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma 2003;54:52-9; 59-60.
6. Nagy KK, Roberts RR, Joseph KT, Smith RF, An GC, Bokhari F, et al. Experience with over 2500 diagnostic peritoneal lavages. Injury 2000;31: 479–482.
7. Lingawi SS, Buckley AR. Focused abdominal US in patients with trauma. Radiology 2000;217: 426– 29.
8. Liu M, Lee CH, P’eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993; 35: 267–70.
9. Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 1999;212: 423–30.
10. Chiu WC, Cushing BM, Rodriguez A, Ho SM, Mirvis SE, Shanmuganathan K, et al. Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma 1997;42: 617–23.
11. Rozycki GS, Ballard RB, Felliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries. Ann Surg 1998;228:557–67.
12. Brown MA, Casola G, Sirlin CB, Budorick N, Patel N, Hoyt DB. Blunt abdominal trauma: screening US in 2693 patients. Radiology 2001;218:352–8.
13. Kuncir EJ, Velmahos GC. Diagnostic peritoneal aspiration-the foster child of DPL: a prospective observational study. Int J Surg 2007;5: 167-71.
14. Udobi KF, Rodriguez A, Chiu WC, Scalea TM. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 2001; 50: 475-9.
15. Soffer D, McKenney MG, Cohn S, Garcia-Roca R, Namias N, Schulman C, et al. Prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury. J Trauma 2004;56: 953-7.
16. Sirlin CB, Brown MA, Andrade-Barreto OA, Deutsch R, Fortlage DA, Hoyt DB, et al. Blunt Abdominal Trauma:Clinical Value of Negative Screening US Scans. Radiology 2004;230: 661–8.