Diagnostic Value of Serial Ultrasound in Blunt Abdominal Trauma


1 Department of Surgery, Kashan University of Medical Sciences, Kashan, IR Iran

2 Department of Radiology, Kashan University of Medical Sciences, Kashan, IR Iran

3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran



Ultrasound has widely been used to assess patients with blunt abdominal trauma and detect free fluid in the abdomen. Nevertheless, different studies reported different false negative for this imaging technique.

The present study was conducted to evaluate the diagnostic value of the repetitive ultrasound in diagnosis of free intraperitoneal fluid.

In this study, 125 patients with abdominal blunt trauma were recruited prospectively for ultrasound evaluation. Ultrasound and CT- scan were performed for all recruited patients in the study. In case of positive ultrasound or CT-scan (free fluid in the peritoneal cavity), patients underwent surgical operation. In the presence of negative ultrasound and CT-scan, and if the patient was alert and had stable vital signs, then, he/she would undergo exact supervision. In such patients, ultrasound and CT-scan were repeated 12 and 24 hours after admission. If any of the tests were positive, the patient underwent laparotomy. Moreover, if ultrasound and CT-scan examinations were negative 24 hours after admission, the patients with normal laboratory tests were discharged according to the surgeon's decision. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Of the 125 patients with abdominal blunt trauma, 90 patients finally underwent laparotomy. Based on the surgical outcome as the gold standard, the initial, 12 hours, and 24 hours sensitivity were measured to be 19.8%, 75.2%, and 82.2%, respectively. These numbers for specificity were 91.7, 75, and 70.8, respectively; they were 90.9, 92.6, and 92.2 for PPV, and 21.3, 41.8, and 48.5 for NPV, respectively.

The sensitivity of ultrasound to detect intraperitoneal fluid in blunt abdominal trauma cases will be increased by repeated ultrasound examinations.


1. Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury? JAMA. 2012;307(14):1517–27. doi: 10.1001/jama.2012.422. [PubMed: 22496266].
2. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin North Am. 2007;25(3):713–33. doi: 10.1016/j.emc.2007.06.002. [PubMed: 17826214] ix.
3. Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. BMJ. 2008;336(7650):938–42. doi: 10.1136/bmj.39534.686192.80. [PubMed: 18436949].
4. Dittrich K, Abu-Zidan FM. Role of Ultrasound in MassCasualty Situations. Int J Disaster Med. 2009;2(1-2):18–23. doi: 10.1080/15031430410024813.
5. Weishaupt D, Grozaj AM, Willmann JK, Roos JE, Hilfiker PR, Marincek B. Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol. 2002;12(6):1295–311. doi: 10.1007/s00330-002-1462-7. [PubMed: 12042933].
6. Nnamonu MI, Ihezue CH, Sule AZ, Ramyil VM, Pam SD. Diagnostic value of abdominal ultrasonography in patients with blunt abdominal trauma. Niger J Surg. 2013;19(2):73–8. doi: 10.4103/1117-6806.119243. [PubMed: 24497755].
7. Kornezos I, Chatziioannou A, Kokkonouzis I, Nebotakis P, Moschouris H, Yiarmenitis S, et al. Findings and limitations of focused ultrasound as a possible screening test in stable adult patients with blunt abdominal trauma: a Greek study. Eur Radiol. 2010;20(1):234–8. doi: 10.1007/s00330-009-1516-1. [PubMed: 19662419].
8. McKenney KL. Ultrasound of blunt abdominal trauma. Radiol Clin North Am. 1999;37(5):879–93. [PubMed: 10494276].
9. Leppaniemi AK, Elliott DC. The role of laparoscopy in blunt abdominal trauma. Ann Med. 1996;28(6):483–9. [PubMed: 9017107].
10. Streck CJ, Jewett BM, Wahlquist AH, Gutierrez PS, Russell WS. Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model? J Trauma Acute Care Surg. 2012;73(2):371–6. doi: 10.1097/TA.0b013e31825840ab. [PubMed: 22846942] discussion 376.
11. Nasr-Esfahani M, Kolahdouzan M, Shafiei M. Ultrasound surface probe as a screening method for evaluating the patients with blunt abdominal trauma. J Res Med Sci. 2014;19(1):23.
12. McKenney KL, Nunez DJ, McKenney MG, Asher J, Zelnick K, Shipshak D. Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients. AJR Am J Roentgenol. 1998;170(4):979–85. doi: 10.2214/ajr.170.4.9580140. [PubMed: 9580140]. 13. Yoshii H, Sato M, Yamamoto S, Motegi M, Okusawa S, Kitano M, et al. Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma. 1998;45(1):45–50. [PubMed: 9680011] discussion 50-1.
14. Mohammadi A, Ghasemi-Rad M. Evaluation of gastrointestinal injury in blunt abdominal trauma "FAST is not reliable": the role of repeated ultrasonography. World J Emerg Surg. 2012;7(1):2. doi: 10.1186/1749-7922- 7-2. [PubMed: 22264345].
15. McGahan JP, Rose J, Coates TL, Wisner DH, Newberry P. Use of ultrasonography in the patient with acute abdominal trauma. J Ultrasound Med. 1997;16(10):653–62. [PubMed: 9323670] quiz 663-4.
16. Rajabzadeh Kanafi A, Giti M, Gharavi MH, Alizadeh A, Pourghorban R, Shekarchi B. Diagnostic accuracy of secondary ultrasound exam in blunt abdominal trauma. Iran J Radiol. 2014;11(3):ee21010. doi: 10.5812/iranjradiol.21010. [PubMed: 25763079].
 17. Boutros SM, Nassef MA, Abdel-Ghany AF. Blunt abdominal trauma: The role of focused abdominal sonography in assessment of organ injury and reducing the need for CT. Alexandria J Med. 2016;52(1):35–41. doi: 10.1016/j.ajme.2015.02.001.
18. Kumar S, Bansal VK, Muduly DK, Sharma P, Misra MC, Chumber S, et al. Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Blunt Trauma Abdomen-A Prospective Study. Indian J Surg. 2015;77(Suppl 2):393–7. doi: 10.1007/s12262-013-0851-2. [PubMed: 26730032].
19. Phul AH, Shah AA, Baloch I. Efficacy & Accuracy of Focused Assessment Sonography for Trauma (FAST) in Management of Isolated Gastrointestinal Injury due to Blunt Abdominal Trauma. Pak J Med Res. 2016;55(2):40A.
20. Helling TS, Wilson J, Augustosky K. The utility of focused abdominal ultrasound in blunt abdominal trauma: a reappraisal. Am J Surg. 2007;194(6):728–32. doi: 10.1016/j.amjsurg.2007.08.012. [PubMed: 18005762] discussion 732-3.
21. Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol. 2007;188(2):415–21. doi: 10.2214/AJR.05.2100. [PubMed: 17242250].
22. Blackbourne LH, Soffer D, McKenney M, Amortegui J, Schulman CI, Crookes B, et al. Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. J Trauma. 2004;57(5):934–8. [PubMed: 15580013].
23. Feyzi A, Rad MP, Ahanchi N, Firoozabadi J. Diagnostic accuracy of ultrasonography in detection of blunt abdominal trauma and comparison of early and late ultrasonography 24 hours after trauma. Pak J Med Sci. 2015;31(4):980–3. doi: 10.12669/pjms.314.6614. [PubMed: 26430442].
24. Healey MA, Simons RK, Winchell RJ, Gosink BB, Casola G, Steele JT, et al. A prospective evaluation of abdominal ultrasound in blunt trauma: is it useful? J Trauma. 1996;40(6):875–83. [PubMed: 8656472] discussion 883-5.
 25. Fleming S, Bird R, Ratnasingham K, Sarker SJ, Walsh M, Patel B. Accuracy of FAST scan in blunt abdominal trauma in a major London trauma centre. Int J Surg. 2012;10(9):470–4. doi: 10.1016/j.ijsu.2012.05.011. [PubMed: 22659310].