Author(s): Fahad Bin Abdul Majeed1, Abdul A. Latheef2, Shajahan Y3
Blunt abdominal trauma is a common case that comes to an emergency department and it is the most easily missed diagnosis resulting in catastrophic consequences. Delay in diagnosing a case is due to the nonspecific character of the symptoms with which it presents. Clinical signs that could be elicited in blunt trauma abdomen are equally nonspecific. Thus, to avoid delay and save the life of the patient, a doctor has to depend on various investigations to rule out blunt trauma abdomen. The modalities which help include paracentesis, diagnostic peritoneal lavage, Focused Abdominal Sonography for Trauma (FAST) and Contrast-Enhanced Computed Tomography (CECT). To choose the right investigation for the right patient helps in saving precious lives. Validity of each investigation, availability, condition of the patient are the main points to look into before deciding on the right investigative modality. Paracentesis is the simplest investigation that could be done in emergency department and also at the site of accident to triage the patient. Paracentesis has low sensitivity to detect blunt trauma. FAST is a better investigation with higher validity rates than paracentesis. This study aims to validate paracentesis, which is the simplest and commonest investigation used to identify blunt abdominal trauma.
MATERIALS AND METHODS
In this study, 106 patients who fulfilled the inclusion and exclusion criteria were followed up by detailed history, clinical examination, paracentesis and FAST to identify blunt abdominal trauma and then compared with a gold standard investigation, which was assigned as CECT for haemodynamically stable patients and laparotomy for haemodynamically unstable patients. Commonest organs injured in blunt trauma and their management was noted. Patients were followed up till discharge or death. Subsequently, the data were compiled using excel sheet and evaluated using tables and charts.
Paracentesis is found to have a sensitivity of 33.3% and specificity of 98.7% in diagnosing blunt abdominal trauma, whereas FAST was found to have a sensitivity of 63% and specificity of 100% in diagnosing the same. With a low sensitivity of 33.3%, paracentesis could not rule out blunt abdominal trauma, but if a patient is found to have a positive paracentesis, the chance of that patient having blunt abdominal trauma is almost 99%. Compared to paracentesis, FAST is a better investigation with 63% chance of diagnosing blunt trauma and a specificity of 100%.
FAST is a better investigation than paracentesis in diagnosing blunt abdominal trauma with higher sensitivity and specificity. But, in centres where FAST is not available, paracentesis may be used, but clinician must keep in mind that a negative paracentesis does not rule out blunt abdominal trauma, whereas a positive paracentesis indicate that the chance of blunt abdominal trauma is almost 100%.
Blunt Abdominal Trauma, Paracentesis, Fast, CECT.